DUPLEX PERICARDIAL PATCH AORTOPLASTY
Erdinc
RESULTS
Eleven patients underwent aortic valve replacement with
this technique. Seven were male and the mean age
(
± standard deviation) was 38.1 ± 17.7 years (range, 16
to 65 years). The goal was to aid aortotomy closure
somewhat supraannularly in 5 patients (23 to 25-mm
pericardial bioprostheses were used) and to implant a
larger prosthesis in 6 others (21 to 23-mm bileaflet
mechanical prostheses were partially anchored to the
patches). The mean aortic crossclamp time was 61.6 ± 7.5
minutes (range, 50 to 77 minutes) and the cardiopulmonary
bypass time was 84.7 ± 10.7 minutes (range, 70 to 105
minutes). The suture lines were dry upon release of the
aortic crossclamps. No additional reinforcement sutures
were required. Postoperative courses were uneventful
except for one case of mild hemiparesis. We did not
observe any aneurysms, perivalvular leakage, or other
complications on postoperative echocardiographic exami-
nations during a mean follow-up of 22.3 ± 13.4 months
(range, 3 to 40 months).
DISCUSSION
Bleeding, although infrequent, remains a serious com-
plication of annular and supraannular aortic enlargement.
Autologous pericardium has been recommended as
favorable patch material to limit this problem. The main
advantages of pericardium over prosthetic material are
considered to be its ready availability, sewing ease,
nonporosity, relative lack of bleeding at the needle holes,
low thrombogenicity, low tendency for flow-related
Figure 1. Abilayer pericardial patch is straddled over the aortotomy and
stitched with a U-suture.
1
–3
hemolysis, and infection resistance. On the other hand,
there are concerns about aneurysm formation, rupture, or
other types of failure of pericardial patches. Although
such complications are rare in the aortic root, there have
been occasional reports of such occurrences in this
2
,3
location. Because of these concerns, glutaraldehyde
treatment has been suggested. Besides providing addi-
tional strength by cross-linking collagen, this treatment
produces better handling properties. However, glutaral-
dehyde is not completely nontoxic and it is known to
5
induce increased calcification in biologic tissues.
We used a single layer of pericardium, with or without
glutaraldehyde treatment, which was satisfactory in our
previous experience of aortic enlargement. During this,
some troublesome bleeding necessitating additional
reinforcement stitches was occasionally encountered.
Furthermore, in a patient with a fragile aorta, re-patching
under a second period of crossclamping was required.
Pericardial and aortic tissues have some incompatibility
with respect to thickness and pliability. This could hinder
Figure 2. The sandwich-suture technique, taking thicker bites from the
pericardial side rather than the aortic rim.
optimal coaptation and contribute to such complications. pericardial patching improved the hemostatic properties
Duplex pericardial patching was conceived to solve those of the pericardium by firmly incorporating the aortotomy
problems. We found it as easy as our previous experience from both sides along the suture lines, which may also
with single-layer pericardial patching and there were no decrease the false-aneurysm risk. Furthermore, this bilayer
excessive time delays related to the technique. Although arrangement strengthened the patch material, which may
limited data are presented herein, we found that duplex prevent true aneurysms.
A
SIAN
C
ARDIOVASCULAR & THORACIC
A
NNALS
74
2000, VOL. 8, NO. 1
Isbell et al.
