[HSF] Technique of the week

[Ben Bidstrup]

Don,
You could superglue closed the end that sits inside the aorta.
You had some shents made - can they not make a suitable aortic occluder.
Call it say 'Easyprox' or Noclamp prox'





>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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-- 


Two things are infinite; the universe and human stupidity; and I am 
not sure about the universe.
Albert Einstein

The greatest obstacle to discovery is not ignorance --- it is the 
illusion of knowledge.
Daniel J Boorstin

Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon