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.

Possible intra-aortic balloon pump "function-related" mechanism of embolic events in patient with protruding atheroma in the thoracic aorta.

A possible new functional mechanism of atheromatous embolus is presented resulting from reversed aortic blood flow during diastolic augmentation by balloon counterpulsation. This mechanism is different from mechanical disruption during insertion. Despite this, intra-aortic balloon remains an important asset in the management of hemodynamically challenged patients.