Eur J Cardiothorac Surg 2001;20:1279
© 2001 Elsevier Science NL
Reply to Akpinar and Guden
John G. Byrne,
Tomislav Mihaljevic,
Sary F. Aranki
Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA
Received 13 September 2001;
accepted 24 September 2001.
Tel.: +1-617-732-7678; fax: +1-617-878-0848
e-mail: jbyrne{at}partners.org
We appreciate the letter by Drs Akpinar and Guden outlining some of the technical details they have learned from performing similar operations on over 40 patients. We agree that peripheral cannulation and circulatory arrest can be very helpful in selected patients, especially if the aneurysm extends close to the arch. In addition to mandatory tension free anastomoses, we have used Tisseel® (Baxter) [1] or more recently, Bioglue® (Cryolife) to reinforce all suture lines. Regarding reoperation, like Akpinar and Guden we have not yet reoperated on any of these patients. However, we believe the reoperation should be similar, in principle, to reoperation on homografts where a stented tissue valve can be placed into the ‘neo annulus’ [2,3]. However, we agree this procedure is most appropriate for the elderly or those who have contraindications to life-long anticoagulation.
References
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Byrne J.G., Mihaljevic T., Lipson W.E., Smith B., Fox J.A., Aranki S.F. Composite stentless valve with graft extension for combined replacement of the aortic valve, root and ascending aorta. Eur J Cardiothorac Surg 2001;20:252-256.[Abstract/Free Full Text]
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Byrne J.G., Karavas A.N., Aklog 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.
