Replacement of the thoracic aorta with intraluminal sutureless prosthesis

Berger, Robert L.; Karlson, Karl J.; Dunton, Robert F.; Leonardi, Howard K.

doi:10.1016/0003-4975(92)91475-o

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…Moreover, the literature shows that this technique significantly reduces the cross-clamp time, the extracorporeal circulation time, and bleeding; [6][7][8]12,13 however, the data on surgical complications and mortality are conflicting. Graver and Tyras 7 and Ergin et al 10 indicated that in the treatment of acute type A aortic dissection, intraluminal sutureless graft insertion helps to reduce the incidence of residual flow in the false lumen and related complications of the distal false lumen.…”

Section: Short-term Resultsmentioning

confidence: 97%

“…13 Although Oz et al 13 reported a low incidence of anastomotic complications, the published data do not permit a definitive conclusion about the long-term benefits of sutureless intraluminal grafts over the conventional sutured technique. 8 Berger et al 8 reviewed the follow-up information on 143 patients who underwent intraluminal sutureless grafts and found that grafting of the thoracic aorta was less hazardous if performed using the sutureless procedure than if using the conventional sutured anastomosis technique, and that long-term function was favorable. However, not all patients were followed up, the followup rate being only 66% (143 of 217 patients), and the surgical backgrounds were heterogeneous.…”

Section: Long-term Resultsmentioning

confidence: 98%

“…[14][15][16][17] Others have argued that the poor long-term results were due to faulty operative technique rather than inherent flaws in the method. 8 Most aortic surgeons agree that intraluminal sutureless grafts have definite limitations in their applicability to the vast majority of patients with aortic dissection and that they should only be used under exceptional circumstances. 14,17 Although the operative procedure conducted in the present study appeared reliable, two graft-related complications (2/16, 12.5%) occurred during follow-up.…”

Section: Long-term Resultsmentioning

confidence: 99%

“…The true lumen was measured, and an appropriately sized preclotted ringed graft was inserted as described previously. 4,8 The proximal spool was introduced into the aortic lumen, and the graft was positioned in the desired location. The nylon tape was tied over the aorta, overlying the groove in the ring without constriction of the lumen.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11] The sutureless intraluminal aortic graft has been used for acute type A aortic dissection, with the advantages of decreasing the graft insertion time and preventing the difficulties inherent in suturing to friable and diseased aortic tissue. However, Séguin et al 12 reported that using the intraluminal sutureless graft for replacement of the ascending aorta in acute aortic dissections resulted in a high rate of surgical complications in the short term.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Surgical Outcomes Following Intraluminal Sutureless Graft Insertion for Type A Aortic Dissection

et al. 2001

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The long-term outcome of sutureless intraluminal graft insertion remains unclarified. Therefore, we reviewed the late surgical outcomes of patients who underwent this procedure for acute type A dissection. Between March 1990 and May 2000, 80 patients aged from 36 to 92 years underwent isolated replacement of the ascending aorta for type A acute aortic dissection. The surgical procedures performed were replacement with an intraluminal sutureless graft in 18 patients (group 1) and suturing of the aorta with a conventional Dacron prosthesis in 62 patients (group 2). The cross-clamp, extracorporeal circulation, circulatory arrest, and operation times were significantly shorter in group 1 than in group 2, and the amount of total blood transfusion was also significantly less in group 1 than in group 2. The hospital mortality rates were 11.1% (2/18) in group 1 and 9.7% (6/62) in group 2 (P> 0.999). The 5-year actuarial survival rates (including operative mortality) were 71% +/- 11% in group 1 and 77% +/- 9% in group 2 (P = 0.268). The event-free survival rates at 5 years were 80% +/- 10% in group 1, and 67% +/- 13% in group 2 (P = 0.780). Regarding graft-related complications, long-term follow-up revealed one graft-related death and one reoperation in group 1 (12.5%), and no graft-related complications in group 2 (0%) (P = 0.047). In conclusion, intraluminal sutureless grafts required less blood transfusion, and shorter cross-clamp, extracorporeal circulation, circulatory arrest, and surgery times. However, the procedure did not improve the hospital mortality or long-term outcome. In fact, the rate of graft-related complications was significantly higher in the intraluminal sutureless group than in the sutured group. Therefore, the intraluminal graft insertion technique should be used only under exceptional circumstances.

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