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Nothing by mouth is necessary to avoid aspiration from stomach contents when starting and finishing anesthesia, but scheduling surgery at 6PM and forcing the patient to starve for the entire day is not ideal . This may also include no liquids. So elective surgeries should be done earlier if...

Being in the medical world for 50 years I have frequently wondered on how much we put patients through that is unnecessary. For example not eating before surgery and scheduling surgery at 6pm. Having surgery and being awoken at 4 am for blood work. There are usually reasons for these things...

https://investors.artivion.com/static-files/65e64285-adde-46c8-a0af-dc67b93977da The trial result mentioned compared an extended run of patients with the ON-X valve at the lower INR with historical data at an higher INR. Interestingly the lower INR had similar stroke like issues and fewer...

The two most competitive mechanical valves used in the US are the St. Jude and the On-X. Probably they are both very similar. On-X has been pushing for lower INR as a selling point for their valves. St. Jude has not done as far as I know, similar studies so does not recommend very low INR...

Good luck.

If there is thought about a robotic approach make sure this is feasible. My understanding is that in re ops especially after multiple surgeries due to scarring the access to the surgical site can be difficult. Hence open surgery may be preferred. Ask the surgeon about this issue and the...

I had three previous surgeries and was faced with a possible fourth for a decompensated leaking mitral valve. I was about to have the surgery at a place known for mitral surgery. I also was in discussion with a cardiologist about mitral clips. At the last minute the surgeon called just before I...

The vitreous humor is a clear jelly that fills the eye and is relatively "thick" early in life. As we age it gets more liquified and large vacuoles of liquified jelly form. At birth the jelly is adherent to the back of the eye but when it gets liquified enough, suddenly the jelly may peel off...

The company concocted a new variable where they basically added the risk of an embolic process to the risk in bleeding. Using this statistic they found no statistical difference between the different INR regimen. So If you rather have a stroke than a bleed go for the low INR approach. I...

I probably had one of the earliest tissue valves placed in 1977 for aortic stenosis. I was 29. Five and a half years later it failed and I had my first St.Jude. It went from 1983 fo 2006 when I needed an aortic aneurysm repaired at age 58. Could have had a tissue but the surgeon who was very...

About thirty five years ago I had the opportunity to visit Hong Kong where I gave some lectures on certain eye conditions. At that time if you had cataract surgery there you had a choice of three levels of care. You could have the locally made lenses put in with some reusable tubing that was...

Just to add to the emboli discussion. They do occur especially if the INR is too low. In my particular case when I had my temporary visual loss episodes they all happened when I was exercising. So perhaps clots start to form on the valve when the INR is low and maybe they will dislodge with...

I don't think this has been noted as much of an issue. I think if there were "micro emboli" some would not be so micro and there would be focal neurological defects that would be long standing. I doubt there is any issue with showering of emboli leading to alterations in brain function that...

Way back when I was in my thirties after my second surgery for aortic stenosis I used to play full court basketball often for two to three hours. One day after playing I had an appointment for a medical checkup. So I went to the university hospital clinic where the nurse greeted me saying...

I don't think in the cardiology world the precise time to deal with mitral insufficiency is super clear. In general mitral insufficiency tends to be a slow process and often can be monitored for quite a long time. I had long standing insufficiency which sudden markedly deteriorated where I...

As far as I am aware the routine use of aspirin after mechanical valve surgery is not universally suggested. If one wants to run a very low INR as suggested by On-X than aspirin should be added to comply with what was done in On-X's trial. As many have mentioned if stroke is a high priority to...

Yes, narcotics will shut down the Gi tract. That is why they are useful when there is diarrhea. Another option is an enema to help clear things out. Again ask if this is an option. It might normalize things quickly. In the old days the nurses used to say about enemas “high,hot and a helliva...

I have no great information about cause of the pain, however, they might be more generous with the pain meds. The pain may actually be a problem in terms of taking deep breaths which is important to combat atelectasis. (Fluid around the lungs with incomplete lung expansion). They may be...

It is both a curse and a good thing that the medical community is based on making money. Many advances have been made due to the potential enormous profits that may occur with a blockbuster. But at the same time there is hype such as claiming a valve will last 20 years when it hasn't been out...

The two issues you are facing are first the hemodynamic function in a valve that is significantly smaller than the current valve. I can give no advice about that but that question needs to be carefully gone over. Second, what is the life expectancy of you and your potential valve? If you do...