[HSF] Technique of the week

Wed Aug 1 15:43:15 EDT 2007

Yes I forgot about the ridiculous approval processes.
Back to the IDC.

>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
>>_______________________________________________
>>OpenHeart-L mailing list
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>_______________________________________________
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon

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