| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2007;84:1425-1426
© 2007 The Society of Thoracic Surgeons
Department of Cardiovascular Surgery, Anthea Hospital, via Camillo Rosalba 35, Bari, 70124 Italy
(Email: alessioamico{at}tiscali.it).
We read the article by Devbhandari and colleagues [1] with great interest. They report the case of a patient who had acute intraoperative malfunction of an aortic prosthetic valve develop due to the use of glue in surgery. Vigorous negative pressure suction inside the aortic root while the glue is being applied may lead to entraining of glue into the aortic lumen. They conclude it is advisable to stop the suction on the left ventricular vent during surgical glue application.
In aortic surgery, we have been using a strong negative suction inside the aortic root during glue application for 3 years. We use this technique in operations of ascending aorta replacement (ie, dissection or aneurysm) with or without the preservation of the native aortic valve.
After aortic root replacement we carefully introduce soft gauze inside the Dacron tube, taking care of the aortic valve; we utilize the Hemashield Platinum Woven vascular graft (Boston Scientific Corp, Natick, MA). If a mechanical prosthesis has been implanted, we thread our gauze through the open leaflets of the valve. In case of a biologic prosthesis or native aortic valve, as in the David reimplantation procedure, we introduce the gauze through the valve to reach the ventricle outflow tract. Moreover, we take care to set the gauze inside the sinus of Valsalva to protect the ostium of the coronary arteries. The following steps are to clamp the Dacron tube (Boston Scientific Corp) and increase the left ventricle aspiration to maximum; collapse of the Dacron tube, a sign of a correct negative pressure, gives us the start time for glue application (Bioglue [CryoLife Inc, Kennesaw, GA]). Due to vigorous negative pressure, the glue is sucked inside the aortic lumen through the suture holes pasting to the gauze. The left ventricle aspiration is then reduced and the clamp removed. Finally we slowly pull out the gauze from the Dacron tube; it is sometimes necessary to apply a light traction to detach the gauze from the suture lines. A careful inspection of the aortic valve (ie, mechanical, biological, or native) is mandatory, and a generous saline solution washing is performed.
We use this technique to reduce bleeding complications during the ascending aorta surgery. Replacement of an acute dissected aorta is obviously the main indication for this procedure. In the beginning of our experience we had observed blocking of one leaflet in a mechanical aortic prosthesis. This complication has taught us to thread the gauze inside the annulus of the prosthesis with open leaflets.
In conclusion, with this artifice we believe it is possible to reduce bleeding complications in every kind of aortic root operation, with or without preservation of the native valve.
 |
References |
|---|
 Top References |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  M. P. Devbhandari and A. J. Duncan Reply Ann. Thorac. Surg., October 1, 2007; 84(4): 1426 - 1426. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
