Eur J Cardiothorac Surg 2001;20:1277
© 2001 Elsevier Science NL
Reply to Urbanski
John G. Byrne,
Tomislav Mihaljevic,
Sary F. Aranki
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
Received 10 September 2001;
accepted 11 September 2001.
Tel.: +1-617-732-7678; fax: +1-617-878-0848
e-mail: jbyrne{at}partners.org
We appreciate the letter by Dr Urbanski clarifying some of the technical details of his operation [1]. Fig. 1 in his letter is particularly helpful in understanding how the 3-mm rim is used in an everting fashion. Regarding kinking of the dacron tube graft, we have not yet experienced this complication and it should be easily avoided by measuring the graft appropriately at the time of operation. Regarding reoperation, we believe our technique may facilitate easier reoperation, should that become necessary, because only the suture line between the Freestyle valve and the tube graft needs to be taken down and a new prosthesis placed into the ‘neo annulus’ of the Freestyle valve. This has been documented to be feasible and safe [2,3]. We believe reoperation using Urbanski's technique may be more cumbersome with the potential need to re-replace the entire conduit. However, both his and our operation seem most appropriate for the elderly and the need for reoperation should be rare using either technique. We do believe however that our technique is perhaps simpler, more reproducible and adds only one additional step (Freestyle-tube graft anastomosis) compared to the classic mechanical valved conduit.
References
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Urbanski P.P., Hacker R.W. Replacement of the aortic valve and ascending aorta with a valved stentless composite graft: technical considerations and early clinical results. Ann Thorac Surg 2000;70:17-20.[Abstract/Free Full Text]
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Byrne J.G., Karavas A.N., Akiog L., Adams D.H., Cheung A., Cohn L.H., Aranki S.F. Aortic valve reoperation after homograft or autograft replacement. J Heart Valve Dis 2001;10:451-457.[Medline]
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Sundt R., III TM, asmi N., Wong K., Radley-Smith R., Khaghani A., Yacoub M.H. Reoperative aortic valve operation after homograft root replacement: surgical options and results. Ann Thorac Surg 1995;60(S95-99):S100.
