Midterm results of aortic repair using a fabric neomedia and fibrin glue for type A acute aortic dissection.
BACKGROUND
Controversy exists concerning the optimal surgical treatment of acute type A aortic dissection to reduce mortality rate and the need for reoperation. The goal of the present study was to evaluate midterm results of repair using a fabric and fibrin glue for acute type A aortic dissection.


METHODS
From 1994 to 2005, 100 patients with acute type A aortic dissection underwent supracommissural graft replacement using a fabric as "neomedia" and fibrin glue. Mean patient age was 65.7 +/- 11.3 years.


RESULTS
Hospital mortality was 9%. All 91 survivors underwent follow-up evaluation for a mean period of 47.7 months. Aortic regurgitation was restored to non or mild in 46 survivors who had preoperative aortic regurgitation in the immediate period, and only one patient developed moderate aortic regurgitation in the midterm period. Survival at 1, 5, and 10 years including hospital mortality was 89.0 +/- 3.1%, 75.2 +/- 5.1%, and 59.2 +/- 10.9%, respectively. Reoperation for aortic lesion was performed without mortality in three patients (residual dissection, n = 1; sinus of Valsalva dilatation, n = 1; acute redissection, n = 1). During two late reoperations, the fabric was observed to be firmly adherent to the dissected wall and maintained the shape of the aorta. Freedom from aortic reoperation was 98 +/- 2% and 98 +/- 2%, at 5 and 10 years, respectively.


CONCLUSIONS
Supracommissural aortic replacement using a fabric neomedia and fibrin glue resulted in low early and late mortality as well as a low reoperation rate.
Nakajima
Takayuki
T
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Iwate Medical University, Morioka, Japan. t_nakajima@imu.ncvc.go.jp
Kawazoe
Kohei
K
Kataoka
Tsuyoshi
T
Kin
Hajime
H
Kazui
Toshinobu
T
Okabayashi
Hitoshi
H
Niinuma
Hiroyuki
H
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013526:Surgical Mesh; D014014:Tissue Adhesives / Q000627:therapeutic use*; D017540:Tunica Media
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives