Cardiovascular Journal of Africa: Vol 27 No 5 (September/October 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016 AFRICA 291
Could the novel ‘double-hole’ technique be an alternative
for the inflow occlusion method?
Sahin Bozok, Gokhan Ilhan, Hızır Kazdal, Berkan Ozpak, Ismail Yurekli, Serdar Bayrak, Mert Kestelli
Abstract
Background: Inflow occlusion on beating heart and cardio-
pulmonary bypass techniques have been proposed for the
removal of foreign material, such as stents, catheters and mass
lesions, from cardiac chambers. However, both techniques are
not devoid of disadvantages and complications. In this article,
we define an alternative, novel ‘double-hole’ technique, which
is based on opening the right atrium without cardiopulmo-
nary bypass.
Methods: Bovine hearts were obtained from a local supermar-
ket. Two purse-string sutures were placed in the right atrium
using 2-0 braided, non-absorbable polyester suture material,
one close to the auricle, and the other close to the intera-
trial septum. The guidewire of a haemodialysis catheter was
inserted through the superior vena cava into the right atrium
and passed all the way through the right ventricle.
Results: We suggest that the double-hole technique may be
useful, especially in revision cases with adhesions. Further
research should be performed to document the efficacy and
safety of this method.
Conclusion: We are aware that further extensive research is
necessary to investigate the utility of this novel technique in
contemporary cardiovascular surgery. We believe the double-
hole technique has the potential to become a safe, practical
and effective measure in the future.
Keywords: inflow occlusion, foreign body, extraction, double-
hole technique, extracorporeal circulation.
Submitted 5/10/15, accepted 2/3/16
Published online 12/4/16
Cardiovasc J Afr 2016; 27: 291–293
DOI: 10.5830/CVJA-2016-020
Inflow occlusion on a beating heart (IOBH) is a technique
that was used more often in cardiovascular surgery before the
cardiopulmonary bypass (CPB) era. Nowadays, this technique
is reserved for cases such as pulmonary or aortic valvotomy,
cardiac injury, atrial septectomy and extraction of intracardiac
thrombus or foreign body. 1-3
CPB can alternatively be used for these operations.
Complications may arise due to technical issues, such as tissue
injury during cannulation or embolic events. Peri-operative
problems arising from the inflammatory process caused by
extracorporeal circulation signify that CPB is not a technique
devoid of complications, in comparison to IOBH.1
To eliminate the disadvantages of IOBH and CPB, we have
developed a novel technique on a bovine heart. We hope that
the ‘double-hole’ technique could provide a safe and effective
alternative in the removal of foreign material such as catheters
and pacemaker leads.
Methods
All animal studies were carried out with the approval of the
Institutional Animal Care and Use Committee. Bovine hearts
were obtained from a local supermarket. Two purse-string
sutures were placed in the right atrium using 2-0 braided,
non-absorbable polyester suture material (Ticron®, Covidien,
Norwalk, CT 06856, USA), one close to the auricle, and the
other close to the interatrial septum.
The guidewire of a haemodialysis catheter was inserted
through the superior vena cava into the right atrium and passed
all the way through the right ventricle. A stab wound was made
within the purse-string sutures and the left index finger was
introduced into the right atrium through the dilated hole, close
to the auricle. In the right hand, a curved haemostatic clamp
was introduced through the dilated hole, close to the interatrial
septum (Fig. 1A). A guidewire or catheter inside the right atrium
was pushed towards the other hole with the tip of the left index
finger and caught with the clamp in the other hole, held by the
right hand, and extracted (Fig. 1B).
Following visualisation and extraction, the wire was cut into
proximal and distal pieces. The proximal piece was extracted
(Fig. 2A), and the distal piece was then removed (Fig. 2B).
Repetition of this procedure revealed that we were able to
retrieve the wire with the clamp every time, and the two pieces
of wire were removed, where after the right atrium was closed
with snares.
Department of Cardiovascular Surgery, Faculty of
Medicine, Recep Tayyip Erdogan University, Training and
Research Hospital, Rize, Turkey
Sahin Bozok, MD,
Gokhan Ilhan, MD
Department of Anesthesiology and Reanimation, Faculty
of Medicine, Recep Tayyip Erdogan University, Training and
Research Hospital, Rize, Turkey
Hızır Kazdal, MD
Department of Cardiovascular Surgery, Faculty of
Medicine, Izmir Katip Celebi University, Atatürk Training
and Research Hospital, İzmir, Turkey
Berkan Ozpak, MD
Ismail Yurekli, MD
Mert Kestelli, MD
Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
Serdar Bayrak, MD