Ann Thorac Surg 1999;67:1163
© 1999 The Society of Thoracic Surgeons
Commentary
Christian Cabrol, MDa
a Department of Cardiovascular Surgery, Hôpital la Pitié, 83 Blvd de l’Hôpital, Paris, F-75013, France
Invited commentary
When we used the aorta-to-right atrial shunt for the first time in a case of uncontrollable bleeding after ascending aorta replacement, we used a 6-mm Dacron shunt. Afterwards we found it simpler to directly connect the tip of right atrial appendage to the aortic aneurysmal sac. We used this technique routinely for 260 cases, without any problems, except in 3 patients. Two patients had a persistent left-to-right shunt. The shunt was minimal in 1 patient who is still without symptoms. The shunt in the second patient was more important, and at reoperation 1 year later, the leak was found easily and closed on the upper aortic suture. In the third patient, the shunt was very important in the immediate postoperative course after aortic replacement for acute dissection. The shunt allowed us to keep the patient alive, and a reoperation was done 4 days later. In that case, the hemorrhage was diffuse around the upper aortic anastomosis, which was displaced down stream on the aortic arch without any further trouble. Furthermore, the Hemashield patch can be replaced easily by a piece of autologous pericardium, which we did in some cases.
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Ann. Thorac. Surg. 1999 67: 1162-1163.
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