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Ann Thorac Surg 1998;65:1194-1195
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Thoracic and Cardiovascular Surgery, University of Massachusetts Medical Center, 55 Lake Ave N, Rm S3-751, Worcester, MA 01655-0304, USA

To the Editor

I am pleased that Dr Satta and his colleagues have used a procedure nearly identical to the one I described [1]. They have used the technique for more years than have we, and it is gratifying that they too have had good results with it.

They contend that the use of a coated Dacron graft has advantages over the polytetrafluoroethylene graft we used; they may be correct. I agree that needle hole bleeding from the polytetrafluoroethylene graft can be a vexing nuisance during full heparinization. We have dealt with that problem in one of two ways. We often perform the polytetrafluoroethylene graft-to-femoral artery anastomosis after giving only 5,000 units of heparin, and give a full heparin dose before instituting cardiopulmonary bypass. We have seen no troublesome or continuing needle hole bleeding with this staged heparin administration.

When our initial heparin dose is sufficient for cardiopulmonary bypass, we manage continuing needle hole blood loss by carrying the shed blood back to the venous reservoir through an extra cardiotomy suction line lying adjacent to the femoral anastomosis, while using towel clips to close the skin over the femoral cannula and suction line, thus creating a small reservoir.

The excellent and infection-free result Satta and colleagues have achieved suggests that a Dacron graft may be preferable to a polytetrafluoroethylene graft. Their cannula-in-a-sleeve technique is ingenious, and one we will adopt when confronted with the need for emergency cannulation.

References

1. Vander Salm T.J. Prevention of lower extremity ischemia during cardiopulmonary bypass via femoral cannulation. Ann Thorac Surg 1997;63:251-252.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas J. Vander Salm Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vander Salm, T. J. Search for Related Content PubMed Articles by Vander Salm, T. J.