Reply to Schepens

I agree with most of the conclusions made by M. Schepens in his letter. With regard to the question of the surgical technique used in the patient with paraplegia, it is obvious that nowadays we would use a left heart bypass to protect the spinal cord. This patient was reoperated in 1992. In those days, the state of the art was not clear for those cases where an aortic cross-clamp time less than 30 min was anticipated [1,2]. I also agree that the primary cause of graft dilatation lies in the knitted graft itself. However, we were able to document that transverse arch hypoplasia predisposes to aneurysm formation in other types of repair [3]. I do not see any reason why this should not be the case in a correction using a distensible graft.

References