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Ann Thorac Surg 2003;76:339
© 2003 The Society of Thoracic Surgeons

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Correspondence

A word of caution on deep pericardial sutures for off-pump coronary bypass procedures

^a Division of Cardiothoracic Surgery, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Ave, East Tower 3072 (R-114), Miami, FL 33136 USA

e-mail: tsalerno{at}med.miami.edu

To the Editor:

Deep pericardial sutures, as described in the article by Fukui and associates [1], are now routinely used in off-pump coronary artery bypass procedures. The three-suture technique described by Ricardo Lima, MD, from Brazil has been replaced by a single-suture technique developed by our group [2]. It was only a matter of time before complications related to the placement of this suture began to appear in the literature. Fukui and co-workers reported the case of a patient with a retropericardial hematoma that was revealed at transesophageal echocardiography during the postoperative period. The hematoma compressed the left atrium anteriorly. I am aware of a patient in whom hypotension developed after placement of the posterior pericardial suture in the oblique sinus to allow exposure of the left anterior descending coronary artery for anastomosis of a left internal mammary artery bypass graft. After a time, blood appeared in the left pleural space, and the surgeon suspected damage to a major vessel posteriorly. On elevation of the heart, there was a large hematoma in the retropericardial region. Despite considerable efforts, which included a left thoracotomy, the patient died. The pericardial suture had been placed in the wall of the aorta transversely. Traction caused the development of a tear, which ultimately led to exsanguination. When applying the posterior pericardial suture, the surgeon has to keep in mind the structures that lie posterior to the pericardial cavity, which include the esophagus and aorta. This suture should be placed superficially in the pericardium. It may be wise to grasp the pericardium with forceps or a clamp prior to placing the suture. As with any new technique, attention to detail is important, and despite its simplicity, the deep pericardial suture can be associated with serious sequelae.

References

1. Fukui T., Suehiro S., Shibata T., Hattori K., Hirai H. Retropericardial hematoma complicating off-pump coronary artery bypass surgery. Ann Thorac Surg 2002;73:1629-1631.[Abstract/Free Full Text]
2. Bergsland J., Karamanoukian H.L., Soltoski P.R., Salerno T.A. "Single suture" for circumflex exposure in off-pump coronary artery bypass grafting. Ann Thorac Surg 1999;68:1428-1430.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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): Tomas Antonio Salerno Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Salerno, T. A. Search for Related Content PubMed PubMed Citation Articles by Salerno, T. A. Related Collections Minimally invasive surgery