title: Low incidence of late pseudoaneurysm and reoperation after conventional repair of acute type a aortic dissection.
abstract: OBJECTIVE
  Suture line dehiscence and pseudoaneurysm formation is one of the leading causes of late reoperation after surgical repair of acute type A aortic dissection (AAD). A sandwich technique can affect the need of reoperation. We sought to assess the late outcomes (mortality and reoperation) of a modified reinforced sandwich technique in conventional AAD repair.
  
  
  METHODS
  Retrospective review of 63 consecutive patients undergoing AAD repair between 2003 and 2013. Aortic anastomosis was performed with a modified reinforced sandwich technique using Hemashield strips and two-layer polypropylene continuous and interrupted mattress sutures.
  
  
  RESULTS
  Marfan syndrome was diagnosed in five (8%) and bicuspid aortic valve in three patients (5%). Twenty-one patients (33%) had preoperative cardiogenic shock necessitating inotropic support. Replacement of the ascending aorta with aortic valve preservation was performed in 58 (92%) and hemiarch replacement in five patients (8%). Four patients died during initial hospitalization, yielding a hospital mortality of 6%. Median follow-up duration was 73 months (range, 1-124). Kaplan-Meier survival rates were 94 ± 3%, 84 ± 5%, and 59 ± 11% at 1, 5, and 10 years. One patient (1.7%) required proximal reoperation 44 months after AAD repair because of progressive dilatation of the aortic root. No patient had severe aortic regurgitation or pseudoaneurysm after AAD repair. Actuarial freedom from reoperation at 1, 5, and 10 years was 100%, 97%, and 97%.
  
  
  CONCLUSIONS
  A reinforced sandwich technique was a good technique resulting in a low incidence of late reoperation and pseudoaneurysm formation.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
authors.forename: Ron-Bin
authors.initials: RB
authors.lastname: Hsu
authors.forename: Jeng-Wei
authors.initials: JW
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000453:epidemiology* / Q000517:prevention & control; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome