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AORTIC DECANNULATION - AN ALTERNATIVE TECHNIQUE

Chief Cardiovascular & Thoracic Surgeon, Department of Cardiac Surgery, Malabar Institute of Medical Sciences Ltd, Mini Bypass Road, Govindapuram PO, Calicut – 673 016, Kerala, India, Tel: 91 495 274 4000, Fax: 91 495 274 1329, Email: mvettathcts{at}hotmail.com

I am herewith enclosing a LETTER TO EDITOR regarding an article that came in the Asian Cardiovascular & Thoracic Annals in - How To Do It section.

An Alternative and Safer Method for Aortic Decannulation.

Manninder S Kalakat, and Jitender M Parmar from the Department of Cardiothoracic Surgery, North Staffordshire Royal Infirmary, West Midlands, UK. Asian Cardiovascular & Thoracic Annals 2005; Volume 13:88–89.

Dr. JP and MSK had described an alternative and safer method for aortic decannulation in this article. At the outset I would like to congratulate them for publishing the article on the use of side clamp for aortic decannulation. Though this technique would have been used by most of the surgeons, it would not have crossed their minds to ever mention this.

Definitely, this could well be an alternative method when things are going bad. But its safety as mentioned by the authors themselves could well be questioned.

As its disadvantages (like- possibility of trauma to aortic wall and dislodgement of plaque or any atheromatous material during the application of side biting clamp) could prove disastrous to the outcome of surgery, its safety is definitely questionable.

In this present era of off pump CABG and Aortic -No Touch technique when surgeons are worried about neurological problems, using a side clamp to decannulate an aorta should be definitely thought about.

Using double purse strings for aortic cannula had reduced the incidence of bleeding. But in case, the purse strings are cut or when the tissues are cut through, use of the Hegars dilator of appropriate size has been very useful. Though I had to use it only a couple of times, I have found having a set of Hegars dilator in the cardiac OR, a very useful tool to be available in the armamentarium of a cardiac surgeon.

If a purse string cuts through, all we need is to block the hole with the left index finger and insert an appropriate sized Hegar into the aortic opening with the other hand. Then conveniently place appropriate purse strings with or without Teflon and remove the Hegar while tightening the purse string.

This is a technique I had learned from Royal Adelaide Hospital, where I had seen Dr. David Craddock, the then Head of Cardiac Surgery, use the Hegar with excellent results. This is the same principle around which the Vettath s Anastomotic Obturator (VAO) had been developed.¹

REFERENCE:

1. Murali.P.Vettath. Vettath s Anastomotic Obturator: A Simple proximal anastomotic device. The Heart Surgery Forum # 2003-73305.6(5), 2003

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vettath, M. P Search for Related Content PubMed PubMed Citation Articles by Vettath, M. P Related Collections Great vessels