J Thorac Cardiovasc Surg 2006;132:728-729
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
John W. Hammon, Jr, MD
Wake Forest University School of Medicine, Department of Cardiothoracic Surgery, Medical Center Blvd, Winston-Salem, NC 27157-1096
We thank Drs Purohit and Zacharias very much for carefully reviewing our manuscript and making comments regarding the study design, techniques, and outcomes. We sincerely appreciate their comments related to agreeing with the single crossclamp method as a valid technique to improve results.
The authors were critical of our inclusion of a nonrandomized, selected group of off-pump patients in this study and including them in the statistical comparisons. We disagree that this weakened the conclusions from the study in that it supports the general idea that reduced aortic manipulation is a valuable technique to improve neurologic and neurocognitive outcomes.
When designing the study, we wanted to compare two techniques of intraoperative management of patients with coronary artery disease. The first, multiple aortic crossclamping, was a tried and true method in our hospital until recently. It involved the use of an aortic clamp that we have shown generates more pressure on the walls of the aorta, as well as multiple applications of partial occluding clamps to the aorta. Our newer technique involves a softer aortic crossclamp and no partial occluding clamps at all. The dramatic difference in the 6-month neurocognitive result amply supports the newer technique.
The authors of the letter were disappointed in the lost opportunity of grading athroma on transesophageal echocardiogram and comparing the results with neurologic outcomes. We reported in our Methods section that each patient received an epiaortic ultrasound scan of the ascending aorta and a transesophageal echocardiogram of the descending aorta. We regret that we failed to publish the fact that there were no statistically significant correlations between ascending or descending aortic atheroma and neurocognitive outcomes in any of the groups. We stated in our Methods section that we believed it was unethical to randomize patients with grade 5 atheromata to multiple aortic clamping, and we still believe that this was the correct decision, as it did not significantly influence outcome.
 |
Acknowledgments
|
|---|
My coauthors and I would like to thank Drs Purohit and Zacharias for their thoughtful comments. We appreciate their careful reading of our manuscript.
Related Article
-
Is the single crossclamp technique superior?
- Manoj Purohit and Joseph Zacharias
J. Thorac. Cardiovasc. Surg. 2006 132: 728.
[Extract]
[Full Text]
[PDF]
