HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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): Cyrus J. Parsa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Parsa, C. J. Articles by Hughes, G. C. Search for Related Content PubMed PubMed Citation Articles by Parsa, C. J. Articles by Hughes, G. C. Related Collections Related Article

---

Correspondence

Reply

Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC 27710

(Email: cyrus.parsa{at}duke.edu).

To the Editor:

On behalf of all the authors, we would like to thank Drs Gammie and Brown [1] for their comments regarding our recent case report [2]. We also acknowledge their vast experience in apicoaortic procedures [3]; however, a few comments warrant clarification. Although our patient exhibited borderline hemodynamic indices at baseline, he was initially and successfully weaned from cardiopulmonary bypass (CPB). Subsequent mucous plug and ventilatory difficulties necessitated re-initation of CPB, not primary cardiac failure. The physiologic insult, however, did not make subsequent separation feasible, and mechanical ventricular support was necessary to wean this patient.

Based on our review of the literature, we recognize that aortic thrombosis is a rare event after apicoaortic conduit (AAC) surgery, and we applaud the authors for their respectable series without such a moribund complication. However, the timing and severity of this complication is what prompted us to recognize this potential catastrophe, and we believe Gammie and Brown [1] would acknowledge that a series of 100 patients may not be large enough to uncover every potential complication occurring with a given procedure.

In summary, ascending aortic thrombosis needs to be recognized as a potential complication of apicoaortic conduit procedures, albeit rare. Furthermore, this discussion will likely become moot in the near future as AAC is once again relegated to the category "of historic interest only," because it is being supplanted by transfemoral and transapical aortic valve replacement procedures. These competing technologies will address a similar population of patients [4] in whom the risk of conventional aortic valve replacement is deemed prohibitive.

Again, we appreciate the experience presented and the comments generated by Gammie and Brown [1] and Gammie and colleagues [3].

	References

Top References

 

1. Gammie JS, Brown JW. Rarity of aortic thrombus after aortic valve bypass (apicoaortic conduit) surgery (letter) Ann Thorac Surg 2010;89:341-342.[Free Full Text]
2. Parsa CJ, Milano CA, Proia AD, Mackensen GB, Hughes GC. A previously unreported complication of apicoaortic conduit for severe aortic stenosis Ann Thorac Surg 2009;87:927-928.[Abstract/Free Full Text]
3. Gammie JS, Krowsoski LS, Brown JM, et al. Aortic valve bypass surgery: midterm clinical outcomes in a high-risk aortic stenosis population Circulation 2008;118:1460-1466.[Abstract/Free Full Text]
4. Kapadia SR, Goel SS, Svensson L, et al. Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement J Thorac Cardiovasc Surg 2009;137:1430-1435.[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): Cyrus J. Parsa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Parsa, C. J. Articles by Hughes, G. C. Search for Related Content PubMed PubMed Citation Articles by Parsa, C. J. Articles by Hughes, G. C. Related Collections Related Article