A Simple Technique to Decrease Gore-Tex Graft Needle Hole Bleeding

Introduction

Gore-Tex grafts (W.L. Gore & Assoc.) are commonly used in pediatric cardiac surgery, particularly in neonates requiring systemic-to-pulmonary shunts.

One of the primary challenges associated with these grafts is bleeding from needle holes at the suture lines. This complication can extend operating room time and necessitate the use of excessive blood products, posing additional risks to the patient.

Tisseel, (Baxter International) a fibrin sealant, is often applied to the suture lines to promote hemostasis. While Tisseel can be effective in achieving general hemostasis, it has limited efficacy in controlling bleeding specifically from needle holes.

We describe a simple surgical technique to increase the effectiveness of Tisseel to control needle hole bleeding.

Technique

After completing the distal anastomosis of the Gore-Tex graft, Tisseel is applied circumferentially along the suture line. A suction tip is then introduced through the opposite end of the Gore-Tex graft and left in place for approximately one minute, allowing the Tisseel to solidify. The suction pulls the Tisseel into the needle holes without allowing it to enter the lumen of the graft (see Figure 1).

OPEN IN VIEWER

Figure 1.

The suction tip is introduced through the opposite end of the Sano shunt, causing the shunt to collapse and the Tisseel to plug the needle holes.

Discussion

This technique has been successfully employed in several patients, primarily in two contexts:

For the distal Sano shunt anastomosis.

Notably, no cases of distal Sano stenosis have been observed with the use of Tisseel applied by this suction method. Pre-Glenn catheterization angiograms showed no evidence of suture line stenosis. Since adopting this technique, the incidence of needle hole bleeding from Gore-Tex grafts has markedly decreased, and no additional sutures have been required for hemostasis. These findings are based on clinical observation rather than quantitative data, as postoperative bleeding during Norwood reconstruction can originate from multiple suture lines, making precise measurement difficult.