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Correspondence

What is the Ideal Patch Material for ASD Closure?

Koray Ak, MD, Yüksel Beir, MD

Marmara University Hospital, School of Medicine, Department of Cardiovascular Surgery, Tophanelioglu Cad. No: 13–15, 34640 Altunizade, Istanbul, Turkey

(Email: akkoray{at}hotmail.com).

To the Editor:

We read with great interest the article by Talwar and colleagues [1] describing a pretty exciting technique for the closure of atrial septal defects (ASDs). They clearly demonstrated that closure of even very complex and challenging ASDs such as complete atrioventricular canal defects can be safely performed by using an autologous right atrial wall patch. They did not recognize any complication related to this particular technique in ASD closure at a mean follow up of 53.4 ± 26.7 months. We congratulate them for such an important contribution to our surgical knowledge.

Talwar and colleagues [1] stated that the main surgical advantages of using an autologous atrial wall patch are the avoidance of prosthetic material, viability, absence of tissue reaction, elasticity, and ease of surgical manipulation. However, we have some concerns about the superiority of preferring a muscular right atrial tissue over a pericardial tissue or synthetic patch. First of all, right atrial wall tissue is quite a loose tissue in consistency. Therefore, it is difficult to manipulate and prone to aneurysm formation. Second, the internal side of the atrial tissue is pretty irregular due to the presence of numerous trabeculations of pectinate muscle of the atrium. Placing such an irregular surface on the left atrial side of the interatrial septum after ASD repair may put the patient at risk for future thromboembolism. Also, hemolysis due to residual jet flow directed toward the atrial patch after repair of atrioventricular canal defects may be more pronounced in patients having a patch with an irregular surface. Third, current experience gathered from maze procedures for atrial fibrillation suggests that full thickness atrial cut or ablation heals by formation of fibrous tissue, and therefore, it results in complete interruption of the propagation of the normal atrial impulse. With this regard, even though they demonstrated the histologic evidence of viability, it seems to be difficult to preserve the electrophysiological integrity and the contractile function of the septal tissue by using a muscular right atrial wall. It is now very well known that ASD repair by using either primary suturing or a patch closure is associated with negligible perioperative complications and excellent long-term outcome [2]. Overall, we believe that using the right atrial wall as patch material carries a considerable number of disadvantages over pericardial tissue and synthetic material in ASD closure.

	References

Top References

 

1. Talwar S, Choudhary SK, Mathur A, Kumar AS. Autologous right atrial wall patch for closure of atrial septal defects Ann Thorac Surg 2007;84:913-916.[Abstract/Free Full Text]
2. Ak K, Aybek T, Wimmer-Greinecker Gerhard, et al. Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year single-institution experience J Thorac Cardiovasc Surg 2007;134:757-764.[Abstract/Free Full Text]

This article has been cited by other articles:

				S. Talwar, S. K. Choudhary, and A. S. Kumar Reply Ann. Thorac. Surg., August 1, 2008; 86(2): 693 - 693. [Full Text] [PDF]

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): Koray Ak Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ak, K. Articles by Besir, Y. Search for Related Content PubMed PubMed Citation Articles by Ak, K. Articles by Besir, Y. Related Collections Congenital - acyanotic Related Article