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.