[HSF] Aortic purse strings in thin large aortas.

[Tea Acuff]

I use 3-0 or 4-0 prolene, two sutures and add another rarely if bleeding is bad around the cannula. Contrary to John I think pulling braided suture is like a gigli saw, but perhaps prolene is like a knife.  Prolene is easier to slowly make the knot tighter. Maybe John's tearing came from pulling the knot too tight.  I see no reason to change or add until after decannulation to see what you have or need to fix. I have done thousands of purse strings without pledgets, but occasionally will add one for a residual leak. I can't remember ever reexploring for lack of pledgets on purse strings, so I sleep okay without them (the usual argument). Thank God for a bad memory. That helps me sleep, too. Why do you feel the need to do it differently? I try to use my best technique on every case. If you are used to 5-0 prolene it should be ideal for thin tissue.
Tea 


----- Original Message ----
From: "ROWLESJOHN at aol.com" <ROWLESJOHN at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, December 2, 2006 7:00:06 PM
Subject: Re: [HSF] Aortic purse strings in thin large aortas.


I use non plegetted  3-0 ethibond  for all of my aortic  pursetring sutures. 
They occasionally need to be enforced with a horizontal  mattress suture and a 
a soft piece of teflon felt.

I used to use prolene but changed to a braided suture and found that it is  
less likely to tear through the fragile tissue.

John Rowles, MD
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