Prevention of aortic anastomotic hemorrhage. A simplified intraoperative testing technique.

BACKGROUND: Postoperative bleeding in aortic root aneurysms had represented a challenge. METHODS: Intraoperative testing of the annular or subannular aortic anastomosis, during procedures involving replacement of the aortic root, with either synthetic tube graft, a composite graft or an allograft is described. By reversing the flow of the LV vent and delivering cardioplegia into the left ventricle and thereby pressurizing the left ventricle and its outflow, this technique enables the surgeon to simulate the volume loaded heart, prior to completion of the distal anastomosis. A systematic assessment of the proximal suture line can then be undertaken. Portions of the proximal suture line, particularly the posterior aspect, are obscured if the inspection takes place after completion of both aortic anastomoses, the coronary attachments, as well as from the presence of the main pulmonary artery and by the distended aorta itself. RESULTS: The use of this method in 34 patients is described without untoward events related to this technique. CONCLUSIONS: The advantages of this technique are a rapid and safe assessment of the integrity of the proximal suture line bed.

Initial clinical experience with rectus sheath grafts in congenital heart defects.

This study reports on the initial clinical experience using anterior rectus sheath as potentially growing graft material in congenital heart lesions. The first seven patients with complex congenital lesions requiring a rectus sheath graft because of inadequate available pericardium are reviewed. The initial operations were: TOF (unicusp pulmonary valve) (re-op), two Konno procedures (one VSD and one RV patch), two arterial switch procedures for TGA (neoaortic augmentation), two Fontan (re-op) atrial augmentation patch and pulmonary arterioplasty (re-op). Ages ranged from 1 week to 15 years. Follow-up ranged from 1 to 72 months and included open visual inspection at reoperation in 5 cases, angiography in 3 cases, and echocardiography in 4 cases. One early respiratory death occurred in the fourth postoperative week. So far no early bleeding from rectus sheath patches, infection, aneurysmal dilatation, or scar contraction was observed. No manifestation of peripheral emboli was seen. Hernias of the harvest site were absent. We concluded that in absence of pericardium and in areas where future cicatrization or aneurysmal dilatation is undesirable, anterior rectus sheath appears to be a reasonable alternative.