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Eur J Cardiothorac Surg 2006;30:816
© 2006 Elsevier Science NL

Letters to the Editor

Reply to Ates and Gullu

Aristotelis Panos, Nicolas Murith

Clinic for Cardiac Surgery, University Hospital of Geneva, Switzerland

Marek Bednarkiewicz

Cardiac Surgery, Hôpital La Tour-Geneva, Switzerland

Gregory Khatchatourov*

Cardiac Surgery, Clinic Cecil, Avenue Ruchonnet 53, CH-1003 Lausanne, Switzerland

Received 31 July 2006; accepted 2 August 2006.

* Corresponding author. Tel.: +41 21 3111424; fax: +41 21 3235153. (Email: g.khatchatourov{at}bluewin.ch).

Key Words: Aortic dissection • Cerebral perfusion • Circulatory arrest

We thank Ates [1] for his remarks and interest in our work [2]. Regarding technical aspects, the prefered type of aortic suture can be a matter of debate. We did not experience any particular problem with the continuous suture or even with the application of narrow teflon felt strip. We believe that when the suture bites are equally distributed and adequately spaced, the anastomosis is bloodproof. Concerning the direct or graft-interposed axillary canulation, we believe that our technique is not traumatic, is less time-consuming, and less hemorrhagic during the operation than the one with the graft interposition. Küçüker et al. [3] performed 181 right brachial artery cannulations for aortic arch operations with only one vascular problem on the brachial artery. The cause of the left arm paralysis in one of our patients was of central origin and not attributed to the cannulation technique. The second patient who was treated with the stent graft suffered from a right arm malperfusion syndrome attributed to the dynamic malperfusion of the right subclavian artery as a result of the recurrence of an intimal flap on the level of the innominate artery. Therefore, we really do not find any ground for Dr Ates's concern about the hypothetical additional risks of the direct axillary canulation. Indeed, as pointed out in our article, one patient died following an acute respiratory distress syndrome on the 20th postoperative day and this was not related to the aortic operation. To answer Dr Ates's last remark concerning the question of deep or moderate hypothermia, we have to say that, of course, it is still a matter of debate and it would be very interesting if Dr Ates and his group published their results and technique on this topic.

References

  1. Ates M, Gullu AU. Which is more appropriate for the right axillary artery cannulation in acute type A aortic dissection–directly or with graft?. Eur J cardiothorac Surg 2006;30:815-816.[Free Full Text]
  2. Panos A, Murith N, Bednarkiewicz M, Khatchatourov G. Axillary cerebral perfusion for arch surgery in acute type A dissection under moderate hypothermia. Eur J Cardiothorac Surg 2006;29:1036-1039.[Abstract/Free Full Text]
  3. Küçüker S, Ozatik M, Saritas A, Tasdemir O. Arch repair with unilateral antegrade cerebral perfusion. Eur J Cardiothorac Surg 2005;27:638-643.[Abstract/Free Full Text]




This Article
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Right arrow Author home page(s):
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Nicolas Murith
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Right arrow Articles by Panos, A.
Right arrow Articles by Khatchatourov, G.
Related Collections
Right arrow Cerebral protection
Right arrow Great vessels

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