Ann Thorac Surg 2007;84:1798-1799. doi:10.1016/j.athoracsur.2007.06.089
© 2007 The Society of Thoracic Surgeons
Correspondence
Long Graft Stumps: A Safe Approach?
Yoshio Ootaki, MD, PhDa,
Naoki Yoshimura, MD, PhDb,
Kiyotaka Fukamachi, MD, PhDc
a Department of Biomedical Engineering/ND20, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
b First Department of Surgery, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
c Department of Biomedical Engineering/ND20, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
(Email: y.ootaki{at}nifty.com; ynaoki{at}med.u-toyama.ac.jp; fukamak{at}ccf.org).
To the Editor:
We read with great interest the article by Cohn and associates [1]. The authors reported that bedside right ventricular assist device (RVAD) removal with a long vascular graft stump had the advantage of avoiding positive pressure ventilation and sternal closure, despite the risk of thrombus liberation and foreign body infection. Several investigators have reported the risk of thrombosis near the stump of the prosthetic graft [2–4]. Although Cohn and associates [1] did not have any complications related to thrombosis or embolization in 10 cases, including 8 cases of left-sided graft stump at the descending aorta with a left ventricular assist device (LVAD), long-term information regarding diagnostic images inside the graft using an echocardiogram or angiogram after removal of an RVAD (or LVAD) would be helpful to understand the safety of this procedure. Pathologic examination inside the graft after its removal at the time of heart transplantation would also be interesting.
Positive pressure ventilation is harmful in the setting of right heart failure. However, an aggressive pharmacologic approach can diminish the risk of positive pressure ventilation [5]. The surgical time for removal of an RVAD with the open chest approach should not be long. The increased interest in the field of ventricular assist devices will lead to safer and more minimally invasive approaches for removal of ventricular assist devices.
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References
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- Cohn WE, Gregoric ID, La Francesca S, Frazier OH. Bedside right ventricular assist device removal in the conscious patient Ann Thorac Surg 2007;83:1556-1557.[Abstract/Free Full Text]
- Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Tei T. Cerebral infarction in children due to thromboembolism from ligated Blalock-Taussig shunt J Thorac Cardiovasc Surg 2000;120:185-186.[Free Full Text]
- Khalil IM, Hoballah JJ. Late upper extremity embolic complications of occluded axillofemoral grafts Ann Vasc Surg 1991;5:375-380.[Medline]
- Kallakuri S, Ascher E, Hingorani A, et al. Endovascular management of axillofemoral bypass graft stump syndrome J Vasc Surg 2003;38:833-835.[Medline]
- Endo GJ, Kojima K, Nakamura K, Matsuzaki Y, Onitsuka T. Nitric oxide inhalation prompts weaning from the right ventricular assist device: evaluation under continuous-flow biventricular assistance J Thorac Cardiovasc Surg 2002;124:739-749.[Abstract/Free Full Text]
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