[HSF] Technique of the week

[Donald Ross]

tea,
Everything is cut off the catheter including all of the balloon just  
leaving the silasic tube. An equivalent solid silastic plunger would  
be better!
Don
On 01/08/2007, at 10:13 AM, Tea Acuff wrote:

> So you drive the needle from the aortic advential side inward into  
> the silastic plunger and move the plunger up and down to remove the  
> needle?  What role does the partially cut balloon play?
> tea
>
>
>
> ----- Original Message ----
> From: Donald Ross <donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thursday, July 26, 2007 7:30:37 AM
> Subject: Re: [HSF] Technique of the week
>
>
> A few eccentric opcab surgeons use  variations of Vettath's
> technique for avoiding side clamping for proximals.
> This uses a metal plug in a punched aortic hole to control bleeding
> while the graft is sewn in the usual way. An adventitial purse string
> stops the hole from enlarging and minimises bleeding when the needle
> is passed against the metal plug "outside in"
> I have used this in 85 cases and Murali Vettath has, by now, done
> several hundred.
> John Brereton, my "anaortic" opcab colleague found the metal plug
> difficult to use and tried a  14F silastic Foley catheter instead,
> driving the needle into the catheter and then withdrawing it together
> with the needle.
> This is a real breakthrough, making the technique really easy and
> more reliable because it ensures the needle actually emerges through
> the aortic hole, never catching any adventitia.
> I used it today on a terrible unclampable aorta which only had a few
> soft spots.
>
> Details:
> The aorta is pulled out of the chest and steadied with heavy
> pericardial  stay sutures places close to the SVC.
> A patch of adventitia is cleared and a 1.0 cm superficial purse
> string of 5-0 proline is placed ( I go round twice )
> The 14F  silastic catheter has the balloon  cut off at an angle and a
> silk marking suture is tied about 6cm from this end. All the bits on
> the other end are cut off and  it is clamped with a haemostat.
> With the pressure <100 a stab in the centre of the purse string is
> made and enlarged with a mosquito clamp to allow the anvil of a 3.5
> mm punch to be introduced. The hole is punched with care to make sure
> it is in the centre, elevating it during the cut helps.
> The catheter/obturator is introduces to the marker and the purse
> string lightly tied.
> ( I leave one end 1 cm long to facilitate cutting it out at the end)
> You need a 5-0 suture with a HALF CIRCLE needle to make wide bites in
> the aorta, driving the point of the needle into the catheter.
> Withdrawing the catheter brings the needle with it which is then put
> into the graft.
> It is best to put the graft down after two passes, keeping the
> working end of the suture short.
> After suturing all the way round with one end, cut out the purse
> string, pull out the catheter and tie down the graft with an
> assistant's finger over it to stop the inevitable few leaks which I
> secure with a 6-0 also on a half circle needle.
> NB The half circle needle is really important.
>
> Don
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