References
1. Bayfield MS, Kron IL. Reducing bleeding after replacement of the aortic root. Ann Thorac Surg. 1995 Oct;60:1130-1.
2. Yakut C. A new modified Bentall procedure: the flanged technique. Ann Thorac Surg. 2001 Jun;71:2050-2.
3. Rousou JA, Alameddine AK, Yang C. A ”double overlap” suture technique for the proximal attachment of a composite graft to the aortic annulus. Ann Thorac Surg. 2007 May;83:19067.
4. Chen LW, Dai XF, Wu XJ. A modified composite valve Dacron graft for prevention of postoperative bleeding from the proximal anastomosis after Bentall procedure. Ann Thorac Surg. 2009 Nov;88:1705-7.
5. Mohite PN, Thingnam SK, Puri S, Kulkarni PP. Use of pericardial strip for reinforcement of proximal anastomosis in Bentall’s procedure. Interact Cardiovasc Thorac Surg. 2010 Nov;11:527-8.
Acknowledgements: None.
Figure 1. New composite, butterfly wing shaped, valve graft fixated using a hand-made double sewing cuff.
After transecting downward from the distal end of the composite graft, circular line along the edge of a sewing cuff was marked on transected graft. The circle was then cut and a ring-shaped polyterafluoroethylene graft was sutured at the upper margin of the sewing cuff using a continuous 4-0 polypropylene suture. Adding an upper sewing cuff to reinforce suturing using the residual aortic wall.
Figure 2, Schematic views of new composite valve graft and anastomotic procedures
A hand-made composite valve graft has two sewing cuffs, that is, a lower sewing cuff (conventional sewing cuff) for annular suturing and an upper sewing cuff (the added polyterafluoroethylene graft) for reinforcement suturing. After conventional annular suturing, reinforcement suturing was performed between the upper sewing cuff and the residual aortic wall to reduce bleeding at the proximal anastomotic site.
Figure 3. Operation field. A. first annular suturing B. second reinforcement suturing.