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Ann Thorac Surg 2005;80:1566-1567
© 2005 The Society of Thoracic Surgeons

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Correspondence

Pericardial Sling Increases OPCAB Safety and Applicability: Reply

Washington University School of Medicine 660 S Euclid Ave Campus Box 8234 St. Louis, MO 63110

(Email: lawtonj{at}msnotes.wustl.edu).

To the Editor:

We thank Mair and colleagues [1] for their comments regarding the safety and efficacy of the use of a deep pericardial sling for off-pump coronary artery bypass graft procedures. In the case we reported, table rotation and both local and apical suction devices were utilized [2]. The rare complication we reported may have been prevented by the placement of similar sutures, and this additional technique may be appropriate in "high-risk" cases.

Prior to our current use of both apical and local suction devices (typically with pressures set at 300 to 350 mm Hg, as lower pressures have resulted in loss of fixation), we utilized a similar deep pericardial suture exposure technique to facilitate mobilization of the heart. We now believe that these deep pericardial sutures are no longer required and are not without risk [3]. Injury to deep structures has been reported including fatal retro-pericardial hematoma from injury to an inferior pulmonary vein [4], fatal aortic tear [3], lung laceration [5], injury to the esophagus [6], and subcutaneous emphysema [7]. Careful attention to detail is one of several tips that have been offered to prevent these complications [8, 9]. However, care must be taken when performing these maneuvers and particularly when attempting to teach them to residents.

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1. Mair H, Daebritz S, Reichart B, Sergeant P. Pericardial sling increases OPCAB safety and applicability(letter) Ann Thorac Surg 2005;80:1565-1566.[Free Full Text]
2. Lawton JS, Deshpande SP, Zanaboni PB, Damiano RJ. Spontaneous atrioventricular groove disruption during off-pump coronary artery bypass grafting Ann Thorac Surg 2005;79:339-341.[Abstract/Free Full Text]
3. Salerno TA. A Word of caution on deep pericardial sutures for off-pump coronary bypass procedures Ann Thorac Surg 2003;76:339.[Free Full Text]
4. Fukui T, Suehiro S, Shibata T, Hattori K, Hirai H. Retroperitoneal hematoma complicating off-pump coronary artery bypass surgery Ann Thorac Surg 2002;73:1629-1631.[Abstract/Free Full Text]
5. Zamvar V, Deglurkar I, Abdullah F, Khan NU. Bleeding from the lung surfacea unique complication of off-pump CABG operation. Heart Surg Forum 2001;4(2):172-173.[Medline]
6. Ricci M, Karamanoukian HL, D'Ancona G, Bergsland J, Salerno TA. Exposure and mechanical stabilization in off-pump coronary artery bypass grafting via sternotomy Ann Thorac Surg 2000;70:1736-1740.[Abstract/Free Full Text]
7. D'Arrigo G, Scolaro A, Lomeo A. Off-pump myocardial revascularization. The single-suture technique: how to avoid any complications Heart Surg Forum 2002;6(1):E10-E11.[Medline]
8. Lima RC. Some technical considerations on the prevention of bleeding caused by sutures in the posterior pericardium in off-pump coronary artery bypass operations Ann Thorac Surg 2004;78:1130.[Free Full Text]
9. Zamvar V. Recommendations for the proper placement of the deep pericardial retraction suture in off-pump coronary artery bypass graft surgery Ann Thorac Surg 2004;78:1130-1131.[Free Full Text]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jennifer S. Lawton Ralph J. Damiano, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lawton, J. S. Articles by Damiano, R. J. Search for Related Content PubMed Articles by Lawton, J. S. Articles by Damiano, R. J., Jr Related Collections Related Article