Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection.
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.
Tanaka
Kuniyoshi
K
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Shimoaizuki 23, Matsuoka-cho, Yoshida-gun, Fukui 910-1193, Japan. kunitan@fmsrsa.fukui-med.ac.jp
Morioka
Kouichi
K
Li
Wei
W
Yamada
Narihisa
N
Takamori
Atsushi
A
Handa
Mitsuteru
M
Tanabe
Sawaka
S
Ihaya
Akio
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D003238:Connective Tissue / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D014014:Tissue Adhesives; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014014:Tissue Adhesives; D011138:Polytetrafluoroethylene