[HSF] Technique of the week

[Donald Ross]

Ben,
If 1000 surgeons wanted to buy such stuff it may possibly cover the  
cost .
The shents cost $18000 but it would cost $30000 to even get them  
approved in OZ so it was a bit of a bummer!
Don
On 01/08/2007, at 11:51 AM, Ben Bidstrup wrote:

> 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
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