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Technical Details Of Minimally Invasive Ascending Aorta Replacement
Zhandong Zhou, MD, PhD1, Charles Lutz
1, Ahmad Nazem
1, Anton Cherney
1, Karikehalli Dilip
1, Mark Lutz
2, Harry Ramcharran
3.
1St. Joseph Hospital, Syracuse, NY, USA,
2SUNY Upstate Medical School, Syracuse, NY, USA,
3Upstate University Hospital, Syracuse, NY, USA.
BACKGROUND: Minimally invasive ascending aorta replacement is still a challenge for many surgeons. The main concern is the suture line bleeding which could be difficult to repair through a small incision. We created a suturing technique that can avoid this problem.
METHODS: The surgery was performed through a 6-7 cm incision in the 2nd intercostal space of the right chest. After establishing peripheral bypass, the aorta was clamped near the arch. Antegrade cardioplegia was delivered. Ascending aorta was resected to 0.5 cm above the sinotubular junction. The graft edge was everted about 0.5 cm. For the proximal anastomosis, the sandwich technique with everted graft inside, aortic wall in the middle and a felt strip outside, was used throughout entire suture line with a running 4-0 prolene suture. For the distal anastomosis, both layers of everted and non everted graft were inside the sandwich for the ease of suturing.
RESULTS: There was no suturing line bleeding after the aortic clamp was removed. No repair sutures were needed. The patient did not need any transfusion with good recovery.
CONCLUSIONS: We believe our suturing technique has excellent hemostatic effect which is ideal for minimally invasive aortic surgery.
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