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Staple Closure of Atriotomy Incision
HOW TO DO IT
Staple Closure of Atriotomy Incision Jack E. Arrants, M.D., and P. Reid Locklair, Jr., M.D. ABSTRACT An alternate method for closure of longitudinal right atriotomy incisions using an auto suture stapling device is described. This rapid and simple technique has been used in 23 patients ranging in age from 16 months to 56 years with very satisfactory results.
I
n both congenital and acquired diseases of the heart a right atriotomy incision is often utilized. The most common congenital defects for which a right atriotomy is used are atrial septal defect, partial anomalous venous return, transposition of the great vessels, and occasional closure of ventricular septal defect through the tricuspid valve. Transseptal replacement of the mitral valve or open valvulotomy is the usual operation for acquired defects in which a right atriotomy incision is used. Once the intracardiac defect is repaired, it is obviously necessary to close the atriotomy incision. The time-honored method of closing the incision is a continuous running stitch with suture material of the surgeon's choice. While this is an effective means of atriotomy closure, an alternate method has recently been used in a large number of patients, both adults and children. Our method of closure of the atriotomy incision has utilized an auto suture stapling device." We had previously found this instrument to be extremely useful in pulmonary procedures, allowing closure of bronchial stumps and pulmonary arteries and veins without fear of leaks. It appeared that the instrument would be ideally suited for atriotomy closure. After testing it in the animal laboratory, we adopted it for clinical use. In children and infants the TA30 with a 3.5 mm. staple is preferred; in adults the TA55 with a 4.8 mm. staple can often be used due to the larger incision. The technique, which is quite simple, requires approximation of the edge of the atriotomy incision at the superior and inferior aspects and in From the Division of Thoracic and Cardiovascular Surgery, Medical University of South Carolina, Charleston, S.C. Accepted for publication April 11, 1974. Address reprint requests to Dr. Arrants, Division of Thoracic and Cardiovascular Surgery, Medical University of South Carolina, 80 Barre St., Charleston, S.C. 29401. *United States Surgical Corp., 845 Third Ave., New York, N.Y. 10022.
638
THE ANNALS OF THORACIC SURGERY
HOW TO DO IT: Staple
Closure of Atriotomy
FIG. 1. Auto stapler in position with three points elevated prior to firing cartridge.
the middle. The auto suture is applied beneath these three points and fired (Fig. 1). Upon closure of the atriotomy incision with the stapler, the right atrium is allowed to fill with blood, and any remaining air present in the atrium is usually extruded through the minute openings made by the small staples. Once the auto suture has been removed, we have not found it necessary to reinforce the line of the closure. Occasionally, due to a large incision, it may become necessary to apply the auto suture twice instead of once. This causes no problem, and the closure remains intact. If the atrium is extremely thin, we recommend the 30-V (2.5 mm.) staple loading unit. The staples are readily visible on roentgenogram (Fig. 2). This method of closure is extremely rapid, and we have become confident with its use in 23 patients ranging in age from 16 months to 56 years. It is now our choice for closure of the usual longitudinal atriotomy incision. FIG. 2. Postoperative shorus auto suture line.
roentgenogram
VOL.
18,
NO.
6,
DECEMBER,
1974
639
Staple Closure of Atriotomy Incision Jack E. Arrants, M.D., and P. Reid Locklair, Jr., M.D. ABSTRACT An alternate method for closure of longitudinal right atriotomy incisions using an auto suture stapling device is described. This rapid and simple technique has been used in 23 patients ranging in age from 16 months to 56 years with very satisfactory results.
I
n both congenital and acquired diseases of the heart a right atriotomy incision is often utilized. The most common congenital defects for which a right atriotomy is used are atrial septal defect, partial anomalous venous return, transposition of the great vessels, and occasional closure of ventricular septal defect through the tricuspid valve. Transseptal replacement of the mitral valve or open valvulotomy is the usual operation for acquired defects in which a right atriotomy incision is used. Once the intracardiac defect is repaired, it is obviously necessary to close the atriotomy incision. The time-honored method of closing the incision is a continuous running stitch with suture material of the surgeon's choice. While this is an effective means of atriotomy closure, an alternate method has recently been used in a large number of patients, both adults and children. Our method of closure of the atriotomy incision has utilized an auto suture stapling device." We had previously found this instrument to be extremely useful in pulmonary procedures, allowing closure of bronchial stumps and pulmonary arteries and veins without fear of leaks. It appeared that the instrument would be ideally suited for atriotomy closure. After testing it in the animal laboratory, we adopted it for clinical use. In children and infants the TA30 with a 3.5 mm. staple is preferred; in adults the TA55 with a 4.8 mm. staple can often be used due to the larger incision. The technique, which is quite simple, requires approximation of the edge of the atriotomy incision at the superior and inferior aspects and in From the Division of Thoracic and Cardiovascular Surgery, Medical University of South Carolina, Charleston, S.C. Accepted for publication April 11, 1974. Address reprint requests to Dr. Arrants, Division of Thoracic and Cardiovascular Surgery, Medical University of South Carolina, 80 Barre St., Charleston, S.C. 29401. *United States Surgical Corp., 845 Third Ave., New York, N.Y. 10022.
638
THE ANNALS OF THORACIC SURGERY
HOW TO DO IT: Staple
Closure of Atriotomy
FIG. 1. Auto stapler in position with three points elevated prior to firing cartridge.
the middle. The auto suture is applied beneath these three points and fired (Fig. 1). Upon closure of the atriotomy incision with the stapler, the right atrium is allowed to fill with blood, and any remaining air present in the atrium is usually extruded through the minute openings made by the small staples. Once the auto suture has been removed, we have not found it necessary to reinforce the line of the closure. Occasionally, due to a large incision, it may become necessary to apply the auto suture twice instead of once. This causes no problem, and the closure remains intact. If the atrium is extremely thin, we recommend the 30-V (2.5 mm.) staple loading unit. The staples are readily visible on roentgenogram (Fig. 2). This method of closure is extremely rapid, and we have become confident with its use in 23 patients ranging in age from 16 months to 56 years. It is now our choice for closure of the usual longitudinal atriotomy incision. FIG. 2. Postoperative shorus auto suture line.
roentgenogram
VOL.
18,
NO.
6,
DECEMBER,
1974
639