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J Thorac Cardiovasc Surg 2004;127:1225
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Department of Surgery (II), Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

We appreciate Ricci's interest in our article,¹ which describes the application of a "modified" central cannulation technique² and open proximal anastomosis technique for surgical repair of aortic coarctation in an adult. We understand Ricci's concern that circulatory arrest to perform open proximal anastomosis is not free from complications. Our strategy of cannulation and cardiopulmonary bypass support for aortic coarctation in an adult is based on our previous experience that aortic injury was caused by crossclamping, in which the portion of coarctation was just distal to the left subclavian branch. As Ricci mentioned in his letter, our proposal of this strategy is based on a single observation; however, it seems safer to use an open proximal anastomosis technique to avoid possible aortic injury not only with crossclamping but also with reliable deep stitches in sufficient sight.

We recently used the same strategy in an operation for distal arch and descending aortic aneurysm. We experienced no technical or clinical problems; therefore, we agree with Ricci that this strategy can serve as a valuable adjunct in patients undergoing complex repairs and reoperations of the distal arch and descending aorta.^3-5

	References

Top References

 

1. Yamada A, Morishita K, Kawaharada N, Fukada J, Satsu T, Abe T. A safe strategy for surgical repair of coarctation of the aorta in an adult. J Thorac Cardiovasc Surg. 2003;126:597–598
   
2. Westaby S, Katsumata T, Vaccari G. Arch and descending aortic aneurysm: influence of perfusion technique on neurological outcome. Eur J Cardiothorac Surg. 1999;15:180–185
   
3. Rokkas CK, Murphy SF, Kouchoukos NT. Aortic coarctation in the adult: management of complications and coexisting arterial abnormalities with hypothermic cardiopulmonary bypass and circulatory arrest. J Thorac Cardiovasc Surg. 2002;124:155–161
   
4. Ricci M, Rosenkranz ER, Salerno TA. Surgical strategy for repair of large pseudoaneurysm of the aortic isthmus. Eur J Cardiothorac Surg. 2001;20:1240–1242
   
5. Gudbjartsson T, Mathur M, Mihaljevic T, Aklog L, Byrne JG, Cohn LH. Hypothermic circulatory arrest for the surgical treatment of complicated adult coarctation of the aorta. J Am Coll Cardiol. 2003;41:849–851
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kiyofumi Morishita Tomio Abe Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yamada, A. Articles by Abe, T. Search for Related Content PubMed PubMed Citation Articles by Yamada, A. Articles by Abe, T. Related Collections Congenital - acyanotic Related Article