The modified adventitial inversion technique as an alternative method for aortic repair in acute type A aortic dissection: Balancing complexity and effectiveness

Motekallemi, Arash; Rukosujew, Andreas

doi:10.1016/j.jtcvs.2019.06.097

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…In the current issue of the Journal, Zhang and colleagues 1 reported their experience in applying the modified Cabrol fistula in surgical repair of acute type A aortic dissection (aTAAD), and the authors should be commended for their good management of this high-risk surgical emergency, especially for their 0% reexploration to check bleeding and low 30-day mortality (2.6%) in the fistula group. 1 Although not emphasized in this article, several intraoperative characteristics were also impressive, such as many complex aortic reconstructions involving the root or arch performed and their short aortic crossclamp and selective cerebral perfusion times.…”

Section: Dissection For Dissection: Limited For Deliberate Cabrol Fismentioning

confidence: 90%

Reply From the authors: Can we just trust our suture lines!

Yang

2020

The Journal of Thoracic and Cardiovascular Surgery

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In this issue of the Journal, Motekallemi and colleagues 1 commented on the techniques of aortic root repair in acute type A aortic dissection (ATAAD) and reported their technique of modified adventitial inversion in contrast to the buttress suture reported by Takana and colleagues. 2 It is a simple technique, as shown in their figure, where they obliterate the false lumen in the aortic root without using Teflon felt or biological glue, which is potentially toxic to the aortic tissue and a challenge for reoperations. 3,4 Surgeons have been very cautious when handling the dissected aorta in ATAAD. The worry of sutures tearing the dissected aorta and dissection flap at the anastomoses supported surgeons using Teflon felt, biological glue, or adventitial inversion as tissue reinforcement. Using adventitia may offer a solution without using Teflon felt or biological glue, both of which, although efficacious, could cause pseudoaneurysms at the anastomotic sites and offer future potential challenges for reoperations. 3,4 The adventitia inversion technique has been used by my colleagues at the University of Michigan as well. However, I personally do not use the inversion of adventitia for the following reasons: (1) aortic adventitia is composed of connective tissue, including fibroblasts, pericytes, and adipocytes in the supporting environment of Author has nothing to disclose with regard to commercial support.

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Section: Dissection For Dissection: Limited For Deliberate Cabrol Fismentioning

confidence: 90%

Reply From the authors: Can we just trust our suture lines!

Yang

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…Proximal anastomosis is a very important part of the operation of acute aortic dissection type A. There are various anastomosis methods, and reports of anastomosis and anastomosis reinforce methods are still ongoing (3,(5)(6)(7)(8). After some transitions, the modified turn-up technique has been the choice for proximal anastomosis if root replacement could be avoided at our institution.…”

Section: Modified Turn-up Technique Has the Potential To Be Comparabl...mentioning

confidence: 99%

Modified turn-up technique for proximal anastomosis in acute aortic dissection type A has potential to facilitate stable outcomes for low-volume early-career surgeons

et al. 2022

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ObjectiveSecure proximal anastomosis is an essential part of surgical treatment for acute aortic dissection type A (AADA). This study aimed to investigate the effectiveness of the modified turn-up technique for proximal anastomosis in AADA and compare this technique with other techniques.MethodsWe divided 57 patients who underwent ascending aorta replacement for AADA into the modified turn-up technique group (group A: 36 patients) and the other technique group (group B: 21 patients). Intraoperative and postoperative course data were compared between groups A and B. In group A, we also compared early-career surgeons (practicing for <10 years after graduation) and aged surgeons (practicing for ≥10 years after graduation).ResultsPreoperative patient characteristics did not differ between groups. There was a tendency toward shorter operation time in group A than in group B without statistical significance (p = 0.12), and the length of intensive care unit stay was significantly shorter (p < 0.01); the occurrence of cerebral infarction was lower (p < 0.01) in group A than in group B, whereas mortality and major complications other than the cerebral infarction rate did not differ between the groups. In group A, 13 patients were operated on by early-career surgeons, while 23 patients were operated on by surgeons with more than 10 years of experience. Aortic clamp time and circulatory arrest time were significantly longer in patients operated on by early-career surgeons, but outcomes were comparable.ConclusionsThe modified turn-up technique was comparable to other techniques. Even for less skilled surgeons (e.g., early-career surgeons), the use of this technique may lead to stable outcomes.

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“…The recent study by Yang and colleagues 1 showed that direct approximation of the dissected layers of the aortic wall using a 5-0 PROLENE running stitch is an equally safe and effective method compared with buttress repair using Teflon or layer fixation with biological glue. Motekallemi and colleagues report a modification 2 to the aortic root repair technique in type A dissection proposed by Tanaka and colleagues. 3 Motekallemi and colleagues propose to invert the redundant adventitia to the inner lumen of the aorta and tacking it to the intima by horizontal mattress sutures using 6-0 PROLENE, and a 4-0 PROLENE running suture was used above the horizontal suture line for false-lumen occlusion.…”

Section: Aortic Root Repair Using Pericardial Autograft For Acute Type a Aortic Dissection To The Editormentioning

confidence: 99%

Aortic root repair using pericardial autograft for acute type A aortic dissection

Guo

Chang

Qian

2021

The Journal of Thoracic and Cardiovascular Surgery

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The modified adventitial inversion technique as an alternative method for aortic repair in acute type A aortic dissection: Balancing complexity and effectiveness

Cited by 4 publications

References 2 publications

Reply From the authors: Can we just trust our suture lines!

Reply From the authors: Can we just trust our suture lines!

Modified turn-up technique for proximal anastomosis in acute aortic dissection type A has potential to facilitate stable outcomes for low-volume early-career surgeons

Aortic root repair using pericardial autograft for acute type A aortic dissection

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