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Ann Thorac Surg 1999;68:2384
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Herz- und Gefäß-Klinik, Salzburger Leite 1, 97616 Bad Neustadt, Germany

e-mail: cachir{at}herzchirurgie.de

To the Editor

I thank Dr Da Col for his comment on our reported technique. If I understand Dr Da Col correctly, he sutures both the tube graft and the prosthetic valve to the aortic annulus. I have abandoned this technique after a few cases. I now move the stentless valve away from the end of the Dacron tube, and only suture the tube graft to the annulus, thus we are able to later remove the prosthetic valve in cases of degeneration, without touching the proximal suture line.

The added security in hemostasis Dr Da Col expects from an additional suture between the Dacron tube and the remnants of the aortic wall, does not seem necessary. Since I started using interrupted plegetted mattress sutures for the proximal anastomosis, we have not observed any bleeding problems in 25 consecutive cases.

I agree with Dr Da Col, that the insertion of the valve prosthesis in a smaller tube is not an optimal solution. Unfortunately, tube grafts in odd sizes, corresponding to the valve sizes, are not commercially available. I feel that the potential hazard of late regurgitation, due to dilation of the Dacron tube as reported by Franke and colleagues [1], is increased when a prosthetic valve smaller than the tube graft is used, as Dr Da Col proposes.

The discussion about oversizing or undersizing could become obsolete, if the composite graft could be prefabricated using a specially designed tube graft of exact matching size, and preferably without crimping at the site of the attachment of the prosthetic valve.

References

1. Franke U., Jurmann M.J., Uthoff K., et al. In vivo morphology of woven, collagen-sealed Dacron prostheses in the thoracic aorta. Ann Thorac Surg 1997;64:1096-1098.[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): Paul P. Urbanski Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Urbanski, P. P. Search for Related Content PubMed Articles by Urbanski, P. P. Related Collections Related Article