Reply to Ates and Gullu
نویسندگان
چکیده
cannulation. The other subject that we wonder about is the cause of mortality in one case. It could be more favorable if the authors pointed out this issue. Antegrade cerebral perfusion is being performed even when the point of deep or moderate hypothermic perfusion is controversial [4]. We believe that the safety and quality of distal anastomosis is the most important factor for mortality and morbidity, so we think that the quality of distal anastomosis is more considerable than wasting time. We use deep hypothermia, but moderate hypothermia can also be used with more experience. An additional comment is that in case of dissection that advanced to left main and right coronary arteries with highgrade aortic insufficiency, bicuspid aorta and degenerative aortic valve disease, we prefer inserting composite graft first and then fixating the upper side of left main coronary artery with pledgeted sutures and suturing just lateral and upper side without down side because of intensive fragility during Bentall operation. Punching the composite graft near the valve and in a slightly horizontal position is enough to achieve this procedure. In our opinion, the surgeon should avoid Bentall procedure as far as possible because resuspension of aortic valve is sufficient in 90% of the cases in acute terms; because of this, tissues become very fragile.
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