title: Dacron Graft Intussusception Technique for Treatment of Type A Aortic Dissections: Technical Notes and Preliminary Results.
abstract: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality.
  
  
  
  The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications.
  
  
  
  Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients.
  
  
  
  Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively.
  
  
  
  This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.
authors.affiliation: Serviço de Cirurgia Cardiovascular, Clinicord, Goiânia, GO, Brazil.
authors.forename: Bruno Botelho
authors.initials: BB
authors.lastname: Pinheiro
authors.affiliation: Hospital Evangélico Goiano, Anápolis, GO, Brazil.
authors.forename: Walter V
authors.initials: WV
authors.lastname: Fagundes
authors.affiliation: Hospital Evangélico Goiano, Anápolis, GO, Brazil.
authors.forename: Luís F F
authors.initials: LF
authors.lastname: Muniz
authors.affiliation: Orebro University Hospital, Orebro, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Dreifaldt
authors.affiliation: Orebro University Hospital, Orebro, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Arbeus
authors.affiliation: Orebro University Hospital, Orebro, Sweden.
authors.forename: Domingos S R
authors.initials: DS
authors.lastname: Souza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000637:transplantation; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D001938:Brazil; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000706:statistics & numerical data; D011093:Polyethylene Terephthalates / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000601:surgery*; D000074286:Preliminary Data; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates