| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2006;30:2-3
© 2006 Elsevier Science NL
Editorial |
Department of Cardio-Vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, CCV, BH 10-275, CH-1011 Lausanne, Switzerland
* Corresponding author. Tel.: +41 21 314 22 79; fax: +41 21 314 22 78. (Email: Ludwig.von-segesser{at}chuv.hospvd.ch).
Sutures have been part of surgery from the very beginning. Despite major improvements made since the use of hemp yarn and catgut, the fact remains that most modern suture material creates holes in the tissue, which are larger than the suture that follows the needle. This in turn induces quite often some degree of unwelcome bleeding. For the application mentioned here, where an apical aperture of the heart has to be closed after the implantation of a valved stent [1,2], the risk of potential or eventual suture tearing is of major concern. There are a number of tricks to control apical bleeding including the preventive and therapeutic use of buttressed sutures with felt or pericardium, gluing of an apical Chinese hat made from pericardium or Teflon felt [3], and even the application of a net for external support or a core cap [4].
For solving a challenging problem, it is sometimes helpful to get inspiration from other disciplines. Construction of tunnels through mud, like for under crossing a river, may serve here as en example. The technical solution, which is applied under such circumstances, is to freeze temporarily the entire zone to be crossed. Tunnel construction with standard equipment for rock mining becomes then possible. Well, we have tried this approach some years ago. The protocol included the laceration of the left ventricle, freezing the left ventricular wall and the blood within the laceration by the means of a cryoprobe which was driven by liquid nitrogen (Fig. 1 ). Once the bleeding was ‘frozen,’ a patch was attached to the epicardium with a running suture, and during thawing the entire ‘repair’ was consolidated by injection of fibrin glue. Although this approach had some success in the animal lab, and larger ventricular orifices could be managed with more freezing power, care has to be taken to avoid major coronary arteries and other vital structures.
|
Of course, there is already a large clinical experience with closure devices within the heart for treatment of septal defects [8]. However, not much is known about the healing properties of such a devices used as seal towards the outside of the circulatory system where secondary bleeding results in cardiac tamponade with all its consequences. At the time of writing, a PubMed search with the term ‘closure device’ brings up 231 items. Most of them deal with the permanent closure of femoral access sites, ASDs, and VSDs, or their respective complications. There are only 15 animal studies and none deals with the problem of permanent repair of left ventricular wall perforations. For more about the future of direct access site device closure, see Ref. [9].
References
This article has been cited by other articles:
|
|
 |
|
  F. Beyersdorf Transapical transcatheter aortic valve implantation Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 7 - 8. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
