Comment
Bleeding from the proximal anastomotic line is problematic and impedes
aortic root replacement using a composite valve graft. Furthermore,
associated increases in operation time lead to reductions in coagulation
factors, the need for blood and blood product transfusions, and increase
the risk of re-exploration due to bleeding. Several techniques have been
introduced since Bentall and De Bono first replaced the aortic root
using a composite valve graft.1-5 Bayfield MS et al.
sutured remnant root tissue to a sewn ring or to a Dacron graft to
reduce bleeding.1 Because a commercial graft can be
used, this technique did not increase operation time but bleeding tended
to occur at needle holes when reinforcement suturing was performed in
the PTFE graft due to an insufficient sewn ring. The method introduced
by Chen LW et al. might result in bleeding at needle holes of a modified
composite valve graft because the Dacron graft used reinforcement
suturing is attached at the lower edge of the composite graft
wall.4 Needle hole bleeding after reinforcement
suturing cannot occur when our technique is used, because the main graft
is not used for reinforcement suturing. Unlike the pericardial strip
technique described by Mohite PN et al., our technique provides savings
in operation time as another surgeon can construct the new composite
valve graft. Furthermore, suture cannot tear because the PTFE graft is
stronger than pericardial strip. 5 The flanged
technique by Yakut C. is similar to our technique, but our technique
allows the added PTFE graft to be handled more easily and produces a
more even suture line than the flanged composite
graft.2
In conclusion, we present a new composite, butterfly wing shaped, valve
graft fixated using a hand-made double sewing cuff that can prevent
proximal anastomosis bleeding by providing homogeneous reinforcement
suture distribution between the added PTFE sewing cuff and the remaining
aortic wall. In addition, the described graft can be handled easily to
enable proximal anastomosis suturing and provide
reinforcement.