title: Adventitial inversion technique for type A aortic dissection distal anastomosis.
abstract: OBJECTIVE
  Anastomosis in dissected aorta management remains challenging. The patent false lumen of remnant aorta influences the growth of the residual aorta after hemiarch replacement. We evaluated the beneficial effect of adventitial inversion technique for distal anastomotic reinforcement of hemiarch replacement in acute type A aortic dissection.
  
  
  METHODS
  From 2006 to 2014, 90 patients with DeBakey type I aortic dissection who underwent hemiarch replacement for acute type A aortic dissection management at the National Cerebral and Cardiovascular Center were retrospectively analyzed. Patients were divided according to the technique used: the adventitial inversion technique in group A and the original Sandwich method with Teflon felt in group S. Surgical variables and aortic morphology from distal aortic anastomosis were evaluated by computed tomography after surgery.
  
  
  RESULTS
  The mean follow-up time was 2.2 ± 2.1 years with a follow-up rate of 91.1%. Cardiopulmonary bypass time was 208.2 ± 93.9 minutes in group A and 220.6 ± 93.9 minutes in group S; lower body circulatory arrest time was 51.6 ± 10.2 minutes in group A and 54.5 ± 17.8 minutes in group S. No significant differences were observed between groups. The overall hospital mortality rate was 10.0%. Postoperative false lumen thrombosis rate at proximal descending aorta on enhanced delayed phase computed tomography was significantly higher in group A than in group S.
  
  
  CONCLUSIONS
  The adventitial inversion technique may facilitate thrombotic closure of the distal false lumen in acute type A aortic dissection management by hemiarch replacement.
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Tatsuya
authors: T
authors: Oda
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: minatoya@ncvc.go.jp.
authors: Kenji
authors: K
authors: Minatoya
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Hiroaki
authors: H
authors: Sasaki
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Hiroshi
authors: H
authors: Tanaka
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Yoshimasa
authors: Y
authors: Seike
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Tatsuya
authors: T
authors: Itonaga
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Yosuke
authors: Y
authors: Inoue
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Junjiro
authors: J
authors: Kobayashi
mesh_terms: D063194:Adventitia / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: adventitial inversion; aortic dissection; aortic reinforcement; felt sandwich; hemiarch replacement