Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection

• Published in: European journal of cardio-thoracic surgery 2005-12, Vol.28 (6), p.864-869
• Main Authors: Tanaka, Kuniyoshi, Morioka, Kouichi, Li, Wei, Yamada, Narihisa, Takamori, Atsushi, Handa, Mitsuteru, Tanabe, Sawaka, Ihaya, Akio
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Anastomosis; Anastomosis, Surgical - methods; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - surgery; Aortic dissection; Aortic surgery; Aortography; Biologic glue; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Connective Tissue - surgery; Diseases of the aorta; Female; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Polytetrafluoroethylene; Postoperative Care - methods; Postoperative Complications; Prognosis; Prosthesis; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tissue Adhesives; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.08.029

Objective: This study was performed to evaluate the clinical usefulness of the adventitial inversion technique in acute type A aortic dissection, with special attention to the impact of this procedure on the postoperative status of false lumen evaluated by computed tomographic scan. Methods: From March 2001 to November 2004, 18 consecutive patients underwent emergent surgery for acute type A aortic dissection. Supracoronary graft replacement was performed in all the patients (ascending aorta/hemiarch replacement: 13/18 = 72%, total arch replacement: 5/18 = 28%). The adventitial inversion technique was used for both the proximal and the distal stump constructions of the dissected aortic wall without the aid of Teflon felt or biologic glue. Aortic regurgitation was treated with resuspension of the aortic commissures. Results: There were two hospital deaths and the overall hospital mortality rate was 11.1%. The mean postoperative blood loss was 635 ± 214 ml and no reexploration was required in any of the patients. Postoperative computed tomography showed closure of the false lumen in aortic root, aortic arch, and proximal descending thoracic aorta in all of the surviving patients. Postoperative echocardiography demonstrated no aortic regurgitation in any of the patients. Two patients died late postoperatively from unrelated causes to aortic dissection. The remaining 14 patients are doing well without a second-stage operation for aortic root or distal aortic lesions during the follow-up period of 7–51 months (mean: 28 ± 14 months). Conclusions: The adventitial inversion technique provides an excellent immediate hemostasis and facilitates thrombotic closure of the proximal and the distal false lumen in the treatment for acute type A aortic dissection.