Long-term integrity of teflon felt-supported suture lines in aortic surgery.
BACKGROUND
Although the ultimate success of aortic operations depends upon the integrity of graft-to-aorta anastomoses, little is known about different techniques used to assure their longevity. We report the incidence of reoperation for suture line disruptions arising from anastomoses using reinforcement with Teflon felt.


METHODS
Since 1987, 1475 patients underwent 2281 anastomoses in the thoracic aorta (mean 1.55/anastomoses per patient). All patients were followed with at least yearly computed tomographic scans, for a total follow-up of 6483.8 patient-years. Those requiring reoperation were reviewed retrospectively for evidence of suture line disruption.


RESULTS
Only 34 patients, with a mean age of 55.1 years old (range 26-85 years old) underwent reoperation for suture-line disruptions following vascular graft-to-aorta anastomosis using Teflon felt. The previous operation was a Bentall procedure in 15 (44%); ascending aorta replacement in 9 (26%); total arch replacement in 6 (18%); descending aorta replacement in 2 (6%); thoracoabdominal repair in 1 (3%); and sinus of Valsalva repair in 1 (3%). The incidence of suture line disruption was 0.0052 per patient-year, and 0.0034 per anastomosis-year. The mean interval between operations was 55.9 months (range 4-180 months). In 21%, the pseudoaneurysm originated from the proximal anastomosis; in 71% from the distal anastomosis; in 3% from both; in 3% from the innominate artery; and in 3% from a sinus of Valsalva repair. In only 1 patient was there evidence of infection. Reoperation involved ascending aorta replacement in 11 patients, and total arch replacement in 13 patients. Adverse outcome, such as hospital death or permanent stroke, occurred in 8% (3 patients).


CONCLUSIONS
Use of Teflon felt to support aortic suture lines yields a very low incidence of suture line disruptions: 1 per 191 patient-years, or 1 per 296 anastomosis-years. Teflon felt reinforcement provides a secure, long-lasting graft-to-aorta anastomosis with minimal risk of infection.
Strauch
Justus T
JT
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine/New York University, New York, NY, USA. ju.strauch@gmx.de
Spielvogel
David
D
Lansman
Steven L
SL
Lauten
Alexander L
AL
Bodian
Carol
C
Griepp
Randall B
RB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods
D011138:Polytetrafluoroethylene