ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

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

Ann Thorac Surg 1998;66:1869
© 1998 The Society of Thoracic Surgeons

Correspondence

Reply

Volker Döring, MD, PhDa, Peter Marcsek, MDa

a Department of Thoracic and Cardiovascular Surgery, University Hospital Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany

To the Editor

We appreciate Dr Sarsam’s comment on our paper entitled. "Atrial Flap Anastomosis: An Alternative Technique for Orthotopic Heart Transplantation" [1]. The letter reflects the still ongoing discussion about the optimal reconstruction of the superior venous inflow tract in orthotopic heart transplantation (oHTx). Dr Sarsam’s bicaval technique [2] prevents a narrowing of the superior vena cava (SVC) anastomosis by connecting an atrial cuff of the recipient SVC with the donor SVC cut obliquely. In case of cava mismatch often present in patients with right heart failure before oHTx he proposes an enlargement of the donor SVC opening by an incision onto the roof of the donor right atrium (RA).

Considering this technique we are concerned about the following aspects: First, using the recipient SVC plus the atrial cuff plus a segment of the proximal donor SVC will result in a considerable length of reconstructed SVC. Was a kinking of the SVC never observed? Second, by using the donor SVC for the construction of this SVC-RA-inflow tract anastomosis, a material with the potential of shrinking is implanted. Third, Dr Sarsam is to be congratulated that he never faced a permanent sinus node dysfunction after having done an incision onto the roof of the RA, where within the terminal sulcus great interindividual variations in the sinus node area are to be expected [3]. This region should be respected as a "no touch area" and never be incised.

In our opinion the "atrial flap" technique represents the following "improvements on already existing techniques" of oHTx: The SVC-RA connection can be done quickly and easily. We never faced bleeding problems of the suture lines within the right atrial appendage. The anastomosis is atrioatrial with a minimal (or zero?) risk of narrowing. Despite of the atrial incision the geometric changes within the RA are negligible, so the risk of incompetence of the atrioventricular valves is small. Because all suture lines are guided more than 1.0 cm distant from the terminal sulcus, the risk of a sinus node dysfunction due to tension, edema, surgical trauma, or sinus artery laceration is minimal.

References

  1. Döring V., Marcsek P. Atrial flap anastomosis: an alternative technique for orthotopic heart transplantation. Ann Thorac Surg 1998;65:1163-1164.[Abstract/Free Full Text]
  2. Sarsam M.A.I., Campbell C.S., Yonan N.A., Deiraniya A.K., Rahman A.N. An alternative surgical technique in orthotopic cardiac transplantation. J Card Surg 1993;8:334-339.
  3. Wilcox BR, Anderson RH. Surgical anatomy of the heart. New York: Churchill Livingstone, 1985:2.3, 2.5.




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

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS