title: A new concentric double prosthesis for sutureless, magnetic-assisted aortic arch inclusion.
abstract: Acute dissection of the ascending aorta is a life-threatening condition in which the aortic wall develops one or more tears of the intima associated with intramural rupture of the media layer with subsequent formation of a two lumina vessel. The remaining outer layer is just the adventitia, with high risk of complete rupture. Vital organs may be under-perfused. Mortality rate in this acute event is about 50% if an emergent surgical procedure is not performed as soon as possible to replace the tract affected by the primary rupture. Nevertheless, the emergent surgical procedure is affected by high risk of mortality or severe neurologic sequelae, due to the need for deep hypothermia and cardiocirculatory arrest and different methods of cerebral protection. If the patient survives the acute event, a frequent outcome is the establishment of a chronic aortic dissection in the remaining aorta and late chronic dissecting aneurysm, usually starting from the surgical suture itself. Traumatism of surgical stitches and of direct blood flow pressure on weak aortic wall can be important contributing factors of the chronic disease. In conclusions, the majority of these patients undergoes a high risk operation without a complete solution of the disease. We hypothesize that excluding the aortic layers from the blood direct flow and using an anastomotic technique which does not include surgical stitches could help to significantly reduce the recurrence of aortic dissection after the acute event and shorten hypothermic arrest duration. We devised a double tubular prosthesis consisting of two concentric artificial tubes between which the aortic wall is confined and excluded from direct blood flow. We also devised a magnetic assisted sutureless anastomotic technique that seals the aortic tissue between the two prostheses and avoids the perforation of the fragile aortic wall with surgical stitches. We are presenting here this new prototype and draw a few different models. Both acute and chronic diseases of the aorta could benefit from the proposed technique, although acute dissection is the ideal scenario for its use.
authors.affiliation: Heart Failure Surgery Unit, Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Italy. Electronic address: marco.cirillo@poliambulanza.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Cirillo
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019544:Equipment Failure Analysis; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D010865:Pilot Projects; D011474:Prosthesis Design; D015607:Stents; D000071062:Sutureless Surgical Procedures / Q000379:methods*