To the Editor:
The case reports of Vrochides and associates 1 describing Pseudomonas mediastinitis at the aortic cannulation site are most remarkable for the potential to avoid such complications. Similar problems were described by Hans Borst in a 1987 paper, “Dire consequences of the indiscriminate use of Teflon pledgets.” 2 Despite such reports, a significant number of cardiac surgeons continue to routinely use Teflon felt pledgets for aortic cannulation.
The use of Teflon felt pledgets is rarely necessary and obviously adds substantial potential for postoperative morbidity and mortality. In the event that cannulation or other sites require buttressing for hemostasis, autologous biologic tissues, including pericardium, fascia, and vein remnants, are almost always available and should be the pledget materials of choice. These autologous tissues rarely become a nidus of infection, nor do they present technical problems at reoperation as pledgets do.
It is imperative that all operations be planned carefully and performed meticulously, so that we “first do no harm.” In the words of Floyd Loop, we should always be mindful that “… the cause of virtually all deaths and serious morbidity relates to performance in the operating room.” 3
Footnotes
Letters to the Editor should be no longer than 2 double-spaced typewritten pages and should contain no more than 4 references. They should be signed, with the expectation that the letters will be published if appropriate. The right to edit all correspondence in accordance with Journal style is reserved by the editors.
References
- 1.Vrochides D, Feng WC, Singh AK. Mycotic ascending aortic pseudoaneurysm secondary to Pseudomonas mediastinitis at the aortic cannulation site. Tex Heart Inst J 2003;30:322–4. [PMC free article] [PubMed]
- 2.Borst HG. Dire consequences of the indiscriminate use of Teflon pledgets. J Thorac Cardiovasc Surg 1987;94:442–3. [PubMed]
- 3.Loop FD. Saphenous vein bypass graft. Modern Techniques in Surgery 1979;10:2–10.