Asian Cardiovasc Thorac Ann 2007;15:162-163
© 2007 Asia Publishing EXchange Ltd
Simple and Secure Aortotomy Closure
Jayapadman Bhaskar, FRCS,
Ashok K Sharma, FRACS
Department of Cardiothoracic Surgery, Wellington Public Hospital, Wellington South, New Zealand
For reprint information contact: Ashok K Sharma, FRACS Tel: 64 4 385 5999 Ext. 5284 Fax: 64 4 385 5538 Email: ashok.sharma{at}ccdhb.org.nz, Wellington Public Hospital, Private Bag 7902, Wellington South, New Zealand.
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ABSTRACT
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We describe a technique for closure of the transverse aortotomy incision after standard aortic valve replacement. This has proved to be an excellent technique that is expeditious and ensures a good seal of the aortotomy edges. It is easily reproducible, with consistently good results.
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INTRODUCTION
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Aortic closure after a standard transverse aortotomy is a simple and straightforward operative step in most cases. However, it can be difficult to attain a tight seal in the increasing number of elderly patients with a badly diseased and thin-walled aorta, with a consequent increasing need for extra pledgetted hemostatic sutures. A simple but novel technique that ensures a tight seal of the aortotomy edges is described.
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TECHNIQUE
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After seating the aortic valve, closure of the aortotomy is started from the surgeon’s end. A 4/0 polypropylene suture is passed outside in from the lower edge, and coming out from the upper flap is repeated again, and the sutures are tied down externally. One of the limbs is used as the running suture outside in from the lower flap, and coming out of the upper flap (Figure 1
). The assistant uses two atraumatic forceps and holds the edges in such a way that the upper flap overlaps the distal flap, thus essentially double-breasting it (Figure 2). This is continued up to the middle of the aortotomy and maintained under tension by the nurse or assistant. The surgeon starts again from the other end of the incision, coming towards the midline, and the two ends are tied down (Figure 3).
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DISCUSSION
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Aortic valve replacement is one of the most commonly performed cardiac operations in adult cardiac surgery today, second only to coronary artery bypass grafting. With an increasing subset of elderly patients with a thin-walled and diseased aorta, various techniques have been proposed to ensure a tight seal. One of the more popular techniques is to close the first layer with mattress sutures and the second layer with an over-and-over suture or a vertical mattress suture.1–3 The technique described here has been found to be superior, with practically no need for extra hemostatic sutures. The rationale is that as the lower flap is within the upper one after the closure, with each systole, the lower flap approximates the upper flap, thus reinforcing the closure. The senior author has routinely used this simple technique for almost 15 years, with excellent results. We would advocate its routine use in every case.
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REFERENCES
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- Hammond GL, Letsou GV. Aortic valve disease and hypertrophic cardiomyopathies. In: Baue AE, Geha AS, Hammond GL, Laks H, Naunheime KS, editors. Glenn’s thoracic and cardiovascular surgery. Vol 2. 6th ed. Stamford, CN: Appleton & Lange, 1996:1988.
- Tsuji HK, Redington JV, Kay JH. Aortotomy closure. Ann Thorac Surg 1967;3:172.[Medline]
- Glower DD. Acquired aortic valve disease. In: Sabiston DC Jr, Spencer FC, editors. Surgery of the chest. Vol 2. 6th ed. Philadelphia: Saunders, 1995:1746.
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ABSTRACT
INTRODUCTION
