title: Perigraft to right atrial shunt by using autologous pericardium for control of bleeding in acute type A dissections.
abstract: BACKGROUND
  We report our experience with creating a perigraft to right atrial fistula by using autologous pericardium to control the inaccessible bleeding after aortic root repair in patients with acute type A aortic dissection.
  
  
  METHODS
  Between 1994 and 2001, perigraft to right atrial fistula was used in 7 of 109 patients (mean age; 55 years) who underwent emergency operation for acute type A dissections. A chamber around the aortic graft was created by suturing a patch of pericardium to the right ventricular wall inferiorly, to the pulmonary artery medially, to the Teflon felt at the distal aortic anastomosis or innominate vein superiorly, and to the superior vena cava and right atrium laterally. A large stab wound was created on the medial aspect of the right atrium. The perigraft space was then closed expeditiously.
  
  
  RESULTS
  None of these patients required reexploration for bleeding and they were discharged from the hospital without complications. The average blood and fresh frozen plasma requirement was 3.4 +/- 0.9 and 2.7 +/- 0.7, respectively. All underwent echocardiographic examination before discharge and no perigraft to right atrial shunt was detected.
  
  
  CONCLUSIONS
  If intractable bleeding is encountered after the administration of protamine and thrombotic agents and a discrete bleeding site can not be found, then a perigraft to right atrial fistula using autologous pericardium can be created as a last resort. It provides primary and definite sternal closure and avoids the detrimental effects of a second pump run and continued bleeding.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Medical School Hospital, Izmir, Turkey. posacioglu@yahoo.com
authors.forename: Haken
authors.initials: H
authors.lastname: Posacioglu
authors.forename: Anil Ziya
authors.initials: AZ
authors.lastname: Apaydin
authors.forename: Tanzer
authors.initials: T
authors.lastname: Calkavur
authors.forename: Tahir
authors.initials: T
authors.lastname: Yagdi
authors.forename: Fatih
authors.initials: F
authors.lastname: Islamoglu
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D012086:Reoperation; D014182:Transplantation, Autologous