How to Control Subannular Hemorrhage during Aortic Root Enlarging Procedures.

Khaled Alameddine,Frederick Conlin,Abdallah Alameddine,Brian Binnall

doi:10.1055/s-0039-1683387

Khaled Alameddine, Frederick Conlin + Show 2 more

Open Access

https://doi.org/10.1055/s-0039-1683387

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Journal: AORTA	Publication Date: Oct 1, 2018
Citations: 1	License type: CC BY 4.0

Affiliation: Swedish Covenant Hospital, Baystate Medical Center

Abstract

We describe an effective suture technique to control the persistent subannular bleeding at the aortoventricular curtain in four patients with aortic stenosis and small annulus who underwent aortic root enlargement and patch reconstruction. This technique approximates the left atrial roof to the aortic root without the need for re-replacement of the aortic prosthesis or revision of the patch. Reintervention for aortic root, valve, or the residual aorta was not required.

Highlights

Ongoing subannular bleeding (SAB) following aortic root enlargement can be life threatening and justifies an aggressive surgical posture
We describe an effective suture technique to control the persistent subannular bleeding at the aortoventricular curtain in four patients with aortic stenosis and small annulus who underwent aortic root enlargement and patch reconstruction
The other option, as we previously reported, is a “U” stitch repair to control bleeding from a damaged intertrigonal area during tissue aortic valve replacement (AVR) by reinforcing the subannular tissue from within the aorta without removing the aortic bioprosthesis.[3]

Summary

Introduction

Ongoing subannular bleeding (SAB) following aortic root enlargement can be life threatening and justifies an aggressive surgical posture. The bleeding site at the aortoventricular curtain cannot be visualized due to the narrow anatomic space as it is subannular under the prosthetic valve sewing ring (whether it is mechanical or bioprosthetic)[3] and risks becoming life threatening. The other option, as we previously reported, is a “U” stitch repair to control bleeding from a damaged intertrigonal area (aortic–mitral curtain) during tissue aortic valve replacement (AVR) by reinforcing the subannular tissue from within the aorta without removing the aortic bioprosthesis.[3]. This technique cannot be used when dealing with a mechanical aortic prosthesis

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Conclusion