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Ann Thorac Surg 2007;84:712-713
© 2007 The Society of Thoracic Surgeons

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Correspondence

Inverted Graft for Construction of an Open Distal Anastomosis in Ascending Aorta and/or Arch Replacement: An Old Technique

Dedinje, Cardiovascular Institute, Cardiac Surgery, Milana Tepica 1, Belgrade, 11000 Serbia

(Email: nezic{at}eunet.yu).

To the Editor:

We also read with great interest the article by Alexiou and Sosnowski [1]. They presented a "new" technique for the construction of a distal open anastomosis during ascending aortic replacement using the inverted graft technique.

Although we accept (supported with personal experience in several cases) all the listed advantages of the aforementioned technique (ie, precise match between the two anastomotic ends; facilitated forehand continuous suture; shortened hypothermic circulatory arrest time; use of the finer suture material, which may be important for achieving hemostasis in the delicate dissected aorta; easy placement of additional sutures, if necessary), we can hardly agree that this is a new technique.

The inversion of the graft within itself (ie, "invagination") was first reported approximately 30 years ago in 1975 by Griepp and colleagues [2], which was to anastomose the graft to the proximal descending aorta for arch replacement in 4 patients. Let me cite a part of their article considering the surgical technique:

"... A preclotted woven Teflon graft is then inverted within itself and inserted in the aortic lumen. A 1 cm wide strip of Teflon felt is positioned outside the aorta and anastomosis of graft to aorta is carried out with a single continuous stitch (Fig 1, B and C). The inverted portion of the graft is then withdrawn from the aorta ..." [2].

Thus, whether you perform the procedure at the beginning or at the end of the aortic arch, using the Teflon strip or not, the technique is basically the same.

Sakamoto and associates [3] have reported the so-called "Calla" method as a simplified procedure for hemi-arch replacement using the open distal anastomosis technique with a partially inverted graft. During open distal anastomosis for type A dissecting aneurysm, the beveled end of the graft (approximately one-quarter of the length) was rolled back (resembling the Calla flower) and inserted into the aortic lumen. The inverted graft was anastomosed using forehand continuous sutures. After completion of the distal anastomosis, the inverted graft was pulled out and then the proximal anastomosis was completed.

Whether the graft is inverted for one-quarter or for the whole length, the technique is basically the same. The part of the hemi-inverted graft is positioned in a fashion that the entire circumference of the end of the hemi-inverted graft is side-by-side to the transected aorta, thus the technical part of the distal anastomosis is the same as Alexiou and Sosnowski [1] have described.

Although several modification of the basic technique [4, 5] have also been previously reported, we congratulate the authors for the largest reported series using inverted graft technique for construction of an open distal anastomosis in ascending aorta replacement.

	References

Top References

 

1. Alexiou C, Sosnowski A. Tube-graft inversion for the construction of an "open" distal anastomosis during ascending aortic replacement: a new technique Ann Thorac Surg 2007;83:326-328.[Abstract/Free Full Text]
2. Griepp R, Stinson E, Hollingsworth J, Buehler D. Prosthetic replacement of the aortic arch J Thorac Cardiovasc Surg 1975;70:1051-1063.[Abstract]
3. Sakamoto T, Yoshida T, Sugano T, Kudoh A, Suzuki A. Simplified technique for hemi-arch replacement during open distal anastomosis: the "Calla" method Ann Thorac Surg 1996;61:1021-1023.[Abstract/Free Full Text]
4. Svensson L. Rationale and technique for replacement of the ascending aorta, arch, and distal aorta using a modified elephant trunk procedure J Card Surg 1992;7:301-312.[Medline]
5. Yoshitatsu M, Nomura F, Toda K, et al. The "eaves" technique for distal anastomosis in aortic arch replacement Ann Thorac Surg 2005;79:1422-1424.[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): Ivan C. Stojanovic Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nezic, D. G. Articles by Stojanovic, I. C. Search for Related Content PubMed PubMed Citation Articles by Nezic, D. G. Articles by Stojanovic, I. C. Related Collections Great vessels