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The Journal of Cardiovascular Surgery 2001 August;42(4):481-4

lingua: Inglese

Prevention of aortic anastomotic hemorrhage. A simplified intraoperative testing technique

Kotsis V. N. a, Connery C. P. a, Azariades P. b, Prappas S. b, Galanos O. a,c, Drossos G. c, Anagnostopoulos C. E. a,b,c

From the
a) Divi­sion of Car­di­oth­o­racic Sur­gery St. ­Luke’s-Roose­velt Hos­pital ­Center at ­Columbia Uni­ver­sity and Con­tinuum ­Health Part­ners, New ­York (USA)
b) Depart­ment of Car­diac Sur­gery Onassis Car­diac Sur­gery ­Center, ­Athens, ­Greece
c) Depart­ment of Car­di­oth­o­racic Sur­gery Uni­ver­sity of Ioan­nina, ­Greece


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Back­ground. Post­op­er­a­tive ­bleeding in ­aortic ­root aneu­rysms had rep­re­sented a chal­lenge.
­Methods. Intra­op­er­a­tive ­testing of the ­annular or sub­an­nular ­aortic anas­tom­osis, ­during pro­ce­dures ­involving replace­ment of the ­aortic ­root, ­with ­either syn­thetic ­tube ­graft, a com­posite ­graft or an allo­graft is ­described. By ­reversing the ­flow of the LV ­vent and deliv­ering car­di­o­plegia ­into the ­left ven­tricle and ­thereby pres­sur­izing the ­left ven­tricle and its out­flow, ­this tech­nique ­enables the sur­geon to sim­u­late the ­volume ­loaded ­heart, ­prior to com­ple­tion of the ­distal anas­tom­osis. A system­atic assess­ment of the prox­imal ­suture ­line can ­then be under­taken. Por­tions of the prox­imal ­suture ­line, par­tic­u­larly the pos­te­rior ­aspect, are ­obscured if the inspec­tion ­takes ­place ­after com­ple­tion of ­both ­aortic anas­to­moses, the cor­o­nary attach­ments, as ­well as ­from the pres­ence of the ­main pul­mo­nary ­artery and by the dis­tended ­aorta ­itself.
­Results. The use of ­this ­method in 34 ­patients is ­described ­without unto­ward ­events ­related to ­this tech­nique.
Con­clu­sions. The advan­tages of ­this tech­nique are a ­rapid and ­safe assess­ment of the integ­rity of the prox­imal ­suture ­line bed.

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