Question: Patient, 77 years old male, has history of nephrectomy Patient presented with complaint of dyspnoea on exertion – II since 7-8 months but had complaint of severe breathless with perspiration since last 10 days and was admitted to hospital where he was diagnosed to have severe AS with acute LVF. Patient was advised for CAG. 2D Echo (21/01/2015) showed LVEF ~ 50%, concentric LVH, mild TR, PAH and severe AS. CAG has shown triple vessel disease, severe AS. So, patient has been advised for CABG + AVR. There were no periprocedural complications. Patient is discharged in stable haemodynamic condition.

On 5th Feb he underwent Angiography. The Angiography reports is as follows :
Indication : Pre AVR CAG, Severe AS
Approach : Right Radial Artery
Catheter : 5F TIG
NYHA / KILLIPS : 1
IABP : No
HAEMODYNAMIC Detail :
AO Sys : 150 mmHg
AO Dias : 80 mmHg
HR : 100 bpm
SPo2 : 100%
Dominance : Right-dominant
LV ANGIOGRAM: Not done
CORONARIES
LMCA : Normal
LAD : 80% lesion after D1.
D1 : Large vessel. 90% lesion at its origin.
LCX : Proximal LCX shows 80% lesion.
OM1 : Normal
RCA : Mid RCA shows 60% lesion
Right PDA shows 805 lesion.
FINAL IMPRESSION:
Pre AVR CAG
Triple Vessel Disease
Severe AS
RECOMMENDATION:
CABG + AVR.
He has been now discharged from the hospital (today 5th Feb 2015) and the discharge summary notes following :
Final Diagnosis
1. Severe Aortic Stenosis (Degenerative)
2. Coronary Artery Disease – Triple Vessel Disease
3. Hypertension
Advice : CABG (Coronary Artery Bypass Graft) + AVR (Aoratic Valve Replacement).
Questions

Local surgeon has given us option for these three valves. I need your advice which valve we should opt for and why.

Company : Hancock . Valve is Medtronic
Company : Therma Fix. Valve is Perimount Edwards
Company : Terma Fix . Valve is Magna Edwards

Local surgeon has given us option for these three valves. I need your advice which valve we should opt for and why.

Company : Hancock . Valve is Medtronic
Company : Therma Fix. Valve is Perimount Edwards
Company : Terma Fix . Valve is Magna Edwards

We have to make decision in next one hour time, so speedy reponse will be of great help.

Regards,

Thanks Dr. Benard.

I still need to go back and check with local surgeon whether he will be using Hancock II, beacuse he just told us Hancock from Medtronic. Are there other models like Hancock or Hancock I etc,.

He spoke very highly about ThermaFix Permount and Magna valves from Edwards. how would you compare these two valves against Hancock II.

Regards,