A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery

Zhu, Cuilin; Piao, Hulin; Wang, Yong; Wang, Tiance; Li, Dan; Xu, Rihao; Zhu, Zhicheng; Li, Bo; Zhang, Yixin; Liu, Kexiang

doi:10.1536/ihj.18-609

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…In our research, the overall proportion of patients with coronary ostia involvement was 81%. Besides, the rate of performing concomitant CABG in all patients was 34%, while that in previous reports ranged from 4 to 7.9% [6,15,16]. To explain this phenomenon, on the one hand, the coronary ostia of our patients might have been more severely involved by dissection because only patients with aortic root involvement were selected.…”

Section: Discussionmentioning

confidence: 76%

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

Liu,

Wang,

Ouyang

et al. 2024

J Cardiothorac Surg

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Background For acute type A aortic dissection involving the aortic root with root diameter no more than 45 mm, there are various aortic root repair techniques. In this study, a novel surgical technique using a pericardial autograft for aortic root repair was introduced. We described its surgical steps in detail and compare its clinical outcomes with direct suture technique. Methods Between July 2017 and August 2022, 95 patients with acute type A aortic dissection who underwent aortic root repair were enrolled, including aortic root repair using pericardial autograft (group A, n = 49) or direct suture (group B, n = 46). The patient’s clinical data were retrospectively analyzed, and a 5-year follow-up was conducted. Results The 30-day mortality, re-exploration for bleeding, postoperative new-onset renal failure requiring continuous renal replacement therapy, stroke, and paraplegia occurred in 3%, 4%, 11%, 5%, and 2% of the overall patients, respectively. There was no significant difference in the 30-day mortality and complication rate between the two groups. The 30-day mortality and re-exploration for bleeding marked the primary endpoint events. Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique (odds ratio, 0.002; 95% confidence interval, 0-0.159; P = 0.026). The aortic valve insufficiency of the two groups were significantly improved after operation (group A, P < 0.001; group B, P < 0.001). During follow-up, there was no significant difference in short-term survival between the two groups after surgery (log-rank P = 0.75), and all patients were free from reoperation for aortic disease. Conclusions Patients who underwent aortic root repair using pericardial autograft tended to have reduced 30-day mortality and a lower risk of re-exploration for bleeding. Using pericardial autograft for aortic root repair is a safe and useful approach for patients with acute type A aortic dissection involving the aortic root.

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Section: Discussionmentioning

confidence: 76%

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

Liu,

Wang,

Ouyang

et al. 2024

J Cardiothorac Surg

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“…Teflon felt could cause extensive adhesions and inflammation, which may prevent the complete healing of the dissected aorta ( 11 , 12 ). Biological glue was another technique used for the repair of aortic root, which has been shown to improve the results of the AAAD surgery ( 2 , 13 ). However, the bioglue compound used for hemostasis may increase the risk of aortic root re-dissection and make possible embolisms in cerebral and coronary arteries ( 14 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…At present, total arch replacement (TAR) plus FET is the most common surgical method for AAAD treatment. However, high postoperative morbidities, such as neurologic deficit, bleeding, paraplegia, and future aortic root dilation, remain challenges for the cardiac surgeons ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of two techniques in proximal anastomosis in acute type A aortic dissection

Fang

Gao

Ren

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe proximal anastomosis is an important procedure during the acute type A aortic dissection (AAAD) surgery. The conventional method is a double patch sandwich technique with Teflon felt. Adventitial eversion and prosthesis eversion technique as a novel approach has been applied to many patients in our center. Herein, This technique would be introduced, and the perioperative and 1-year follow-up results of the two different anastomosis methods were also evaluated.MethodsBetween December 2017 and May 2021, 143 AAAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation were included in this retrospective study. Patients were divided into the eversion technique group (adventitial eversion and prosthesis eversion technique for proximal anastomosis, n = 64) and the sandwich technique group (n = 79).ResultsThe medical records were analyzed and compared between the groups. The mean operation time was 466 ± 73 min in the eversion technique group and 513 ± 81 min in the sandwich technique group (P < 0.001). Compared with the sandwich technique group, the eversion technique group also showed a shorter time on proximal anastomosis (38 ± 12 min vs. 58 ± 20 min, P < 0.001), cardiopulmonary bypass (195 ± 26 vs. 211 ± 40 min, P = 0.003), and aortic cross-clamp (120 ± 23 min vs. 134 ± 27 min, P = 0.002). Furthermore, a decreased proportion of >600 ml fresh frozen plasmas transfusion was observed in eversion technique group (10.9% vs. 34.2%, P = 0.002). No statistical differences were found in the postoperative morbidities and 1-year follow-up outcomes.ConclusionProximal anastomosis with adventitial eversion and prosthesis eversion technique is a promising surgical option for AAAD patients, with favorable perioperative and 1-year follow-up results.

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“…The surgical techniques included Liu’s aortic root repair technique ( 8 ), Liu’s aortic arch inclusion technique with frozen elephant trunk ( 9 ), and mild-moderate hypothermic technique. The Liu’s aortic arch inclusion technique with frozen elephant trunk was indicated for all patients admitted for TAAD treatment after screening for the following exclusion factors: (1) a primary tear involving the orifices of the 3 brachiocephalic vessels; (2) a primary tear located between the innominate artery (IA) and left common carotid artery (LCCA) in the greater curve of the aortic arch.…”

Section: Methodsmentioning

confidence: 99%

“…Then, 3 to 5 additional 4-0 polypropylene vertical mattress sutures were placed above between the proximal and distal horizontal sutures within the proximal reconstructed aortic root, to further split the false lumen into pieces and promote the process of false lumen thrombosis. Thus, the aortic root reinforcement procedure was completed ( 8 ).…”

Section: Methodsmentioning

confidence: 99%

Ministernotomy approach to aortic arch inclusion and frozen elephant trunk in the treatment of acute Stanford A aortic dissection

Wang

Piao

et al. 2022

Front. Cardiovasc. Med.

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This study aimed to report our results of ministernotomy approach to Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with frozen elephant trunk (FET) in the treatment in type A aortic dissection (TAAD). We retrospectively analyzed data on 68 Stanford A aortic dissection patients from October 2017 to March 2020. All patients underwent Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with FET and mild-moderate hypothermic circulatory arrest combined with ministernotomy approach. 154 TAAD patients between January 2014 and December 2016 underwent complete sternotomy were selected as control group. Clinical characteristics, data during operation, in-hospital and postoperative outcomes of these patients were observed. The mean hypothermic circulatory arrest time in ministernotomy Patients was 39.3 ± 7.9 min, aortic cross-clamp time was 105.9 ± 12.8 min, cardiopulmonary bypass time was 152.8 ± 24.3 min. Three patients died of multiple organ dysfunction syndrome in ministernotomy Patients. Perioperative temporary neurological dysfunction occurred in three (4.41%) patients, and 53 (77.9%) patients did not require any blood product transfusion during and after operation in ministernotomy Patients. Postoperative CT angiography (CTA) examination at 6-32 months showed excellent outcomes except in three (4.41%) cases where arch false lumen patency persisted. The Liu’s aortic root repair technique, Liu’s aortic arch inclusion technique with FET and mild-moderate hypothermia circulatory arrest simplify the surgical procedure and reduce bleeding, which can be accomplished through minimally invasive approach.

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A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery

Cited by 7 publications

References 29 publications

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

Comparison of two techniques in proximal anastomosis in acute type A aortic dissection

Ministernotomy approach to aortic arch inclusion and frozen elephant trunk in the treatment of acute Stanford A aortic dissection

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