[HSF] Technique of the week

[erdinç naseri]

Don,
Do you observe more bleeding than ususal while constructing the anastomosis this way.
erdinc> From: donross at bigpond.com> Subject: Re: [HSF] Technique of the week> Date: Thu, 26 Jul 2007 22:30:37 +1000> To: OpenHeart-L at lists.hsforum.com> CC: > > > 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> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------