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Ann Thorac Surg 1998;66:609
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a The Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA

To the Editor

Thank you for allowing me to respond to the letter from Browdie and Bernstein regarding the hemostatic effect of "sealing" sewing rings in aortic root replacements. I have no doubt that sewing ring porosity is a contributing factor to hemorrhage. I also feel strongly that a secure proximal anastomosis is mandatory because postbypass exposure of much of this area is extremely difficult and the act of exposing may exacerbate tears or leaks. Further, if one is confident of his or her proximal anastomosis, there is no need to cover the composite graft/coronary button construction with aortic wall. It is for this reason that I and my colleagues have adhered to the tandem suture line technique (a proximal interrupted suture line followed by a slightly more distal running suture line) as reported in 1993 [1]. Since then our experience with the tandem suture line has included a number of different manufacturers’ composite grafts, some composite grafts constructed in the operating room using tissue prostheses, as well as homograft and pulmonary autograft root replacements. We have been pleased with the technique and recommend that it be used widely in root replacement even with composite prostheses featuring "sealed" or nonporous sewing rings.

References

1. Copeland J.G., III, Rosado L.J., Snyder S.L. New technique for improving hemostasis in aortic root replacement with composite graft. Ann Thorac Surg 1993;55:1027-1029.[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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jack G. Copeland Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Copeland, J. G. Search for Related Content PubMed PubMed Citation Articles by Copeland, J. G.