Aortic decannulation--an alternative technique.
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Aorta↗
Biomedical subjects
Murali P Vettath
Publications and source records attributed to Murali P Vettath.
Off-pump excision of left atrial appendage aneurysm: a case report.
Isolated congenital intrapericardial aneurysm of the left atrium (LA) or the left atrial appendage (LAA) is a rare anomaly [Zhao 1999]. The patient usually presents with features of systemic embolization, serious arrhythmia, and severe congestive cardiac failure as a complication, which can be fatal. Once the condition is diagnosed, surgery is indicated [Zhao 1999]. We report a case of congenital left atrial appendage aneurysm in a woman who underwent excision of the same.
Adult↗
Vettath's anastamotic obturator--our experience of 269 proximal anastomoses.
BACKGROUND: Coronary artery bypass grafting (CABG) has come full circle-it started as an off-pump affair, then became an on pump one and now we are trying to keep off the pump again. One of the main reasons for this has been the neurological sequelae subsequent to CABG. But neurological problems kept causing concern even in off-pump CABGs (OPCAB). Side clamping the aorta was thought to be the major factor and thus came the concept of 'no touch proximal anastomoses' onto the aorta (1). Though a variety of proximal anastamotic devices are available in the market, high cost is a matter of real concern in third world countries like India. Hence, this endeavor of ours to fabricate an anastamotic device of our own-'the Vettath's anastamotic obturator' (VAO) for proximal anastomoses of saphenous vein grafts (SVG) onto the aorta. VAO is a stainless steel rod with three grooves and a guard at the end, which sinks into the aorta, through a punch hole, cordoned off by two wide purse string sutures. METHODS: After trials on perfused animal heart models, we started using this device on humans. We have performed 269 proximal anastomoses using the VAO in 177 of our OPCAB patients in the past 1 year (till July 2003). Ninety-five of them had single top ends, 72 had 2 top ends and 10 had 3 top ends onto the aorta. We have used this on disease free islands on four patients with palpable aortic plaques. Initially all anastomoses were of the proximal first type (to ensure that the flow was adequate). Now-a-days, with confidence, distal first anastomoses are being performed. RESULTS: We had no operative mortality in this group. None of our patients needed IABP support. One patient reported back with angina, after 3 months-he was studied and his grafts were found to be patent. All patients, except three, are being followed up till date and they are leading active symptom free and event free lives. DISCUSSION: It is logical to think that avoidance of side clamp on the aorta reduces the risk of neurologic complications. Vettath's anastamotic obturator is an indigenous, cheap and reusable alternative to the other costlier devices, which serve the same purpose. Though there is a small learning curve, results are gratifying and complications are few.
Journal Article↗
Vettath's anastomotic obturator: a simple proximal anastomotic device.
BACKGROUND: Off-pump coronary artery bypass grafting has been shown to improve the postoperative course of patients undergoing coronary artery bypass grafting (CABG) surgery, but the need for side-clamping the aorta to perform the proximal anastomosis is still a risk factor for causing neurologic injury postoperatively. Hence, our endeavor to fabricate an obturator to perform the proximal anastomosis without side-clamping the aorta is described. METHODS: From July 2002 to February 2003, we performed more than 150 CABG surgeries in our new cardiac center, and 92 patients had proximal saphenous vein graft anastomoses performed with Vettath's anastomotic obturator (VAO). RESULTS: A total of 147 CABG surgeries (98%) were performed on the beating heart, of which 135 (90%) were done off-pump. Early in our experience, the top ends were performed with side-clamping until we introduced our new VAO after trials on a perfused animal heart model. Ninety-two patients had proximal anastomoses carried out with the VAO, and 97 proximal anastomoses were performed on the aorta, because 5 of the patients had 2 proximal anastomoses. We had only one patient in our series who came back with angina after 3 months. Results of repeat coronary angiography with this patient showed a patent proximal anastomosis and no graft problems. CONCLUSION: Our initial results with the VAO have been excellent. We have been able to use it in all of our proximal anastomoses of late. With regular practice, this procedure can be performed with ease and can definitely avoid the neurologic deficits caused by side-clamping the aorta.
Anastomosis, Surgical↗