590’ The Annals of Thoracic Surgery Vol 29 No 6 June 1980
ruptured abdominal aortic aneurysm, it was learned that no woven graft was available. A double velour bifurcation graft* was inserted in the usual manner, and the cross-clamp was slowly removed. Initially the graft displayed copious “sweating” of blood, and the cross-clamp was reapplied for a few minutes. Upon removal of the clamp, the graft was seen to be completely hemostatic, even before protamine had been given systemically. This experience has been repeated in 4 additional patients, with the same result in all 4. I agree with the manufacturer‘s recommendation to preclot all knitted Dacron grafts whenever possible. Nevertheless, in an emergency situation, a double velour graft may be used in the already heparinized patient. The denser pile of the double velour results in lower porosity than standard knitted grafts, probably allowing platelets to act as the primary hemostatic agent.
with more than 1,500 prosthetic valve implants in all positions over the last 10 years does not support that assumption. The incidence of paravalvular leak requiring reoperation (1.5%) in more than 600 single mitral valve replacements with the Beall valve (vertical cuff) using continuous suture was not significantly different from the incidence of this complication (1.9%) in 336 mitral valve replacements using the same valve with interrupted sutures [21. No case of massive paravalvular leak occurred in the group of patients with continuous suture. In isolated aortic valve replacement with the Bjork-Shiley valve, we usually use interrupted sutures for valve insertion. The incidence of paravalvular leak was low (4%) regardless of the type of suture technique [l]. In fact, the only patient in whom massive aortic regurgitation developed had detachment of the interrupted sutures from the annulus, secondary to subacute bacterial endocarditis with abscess of the aortic root. The use of continuous suture may be of benefit to T . E. Theman, F.R.C.S.03 the patient. Since the cardiac ischemia time is reduced by half with this technique, myocardial injury Department of Surgery is minimized. This can be important in patients with Memorial University of marginal cardiac reserve. The three preconditions for Newfoundland this method of valve fixation are: a prosthesis or tisSt. John’s, sue valve with the sewing cuff designed for this Newfoundland, Canada A1 B 3V6 purpose, a valve annulus without severe calcifica‘Cooley Double Velour Guideline Grafts, Meadox Medicals tion, and a surgeon experienced in the technique. Inc., Oakland, NJ 07436. Javier Fernandez, M . D .
Department of Thoracic and Cardiovascular Surge y Deborah Heart and Lung Center Browns Mills, NJ 08015
Continuous Suture in Valve Replacement To the Editor:
In his editorial ”Factors Determining Outcome of Cardiac Valve Replacement” (Ann Thorac Surg 27:101,1979), Dr. Roberts expressed the view that the use of interrupted sutures would be less likely than a continuous suture technique to be associated with massive prosthetic regurgitation. Our experience
1. Fernandez J, Morse D, Maranhao V, et al: Results of use of the Pyrolite carbon tilting disc BjorkShiley aortic prosthesis. Chest 65540, 1974 2. Nichols HT, Fernandez J, Morse D, et al: Improved results in 336 patients with the isolated mitral Beall valve replacement. Chest 62:266, 1972