Use of an Intraluminal Double-ring Vascular Prosthesis in Thoracic Aorta Reconstruction

Hejnal, J; Firt, P

doi:10.1055/s-2007-1022175

Cited by 4 publications

(2 citation statements)

References 1 publication

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“…Some surgeons have found sutureless intraluminal graft insertion to be an unsatisfactory method due to its high incidence of late complications. [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.…”

Section: Long-term Resultsmentioning

confidence: 99%

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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Section: Long-term Resultsmentioning

confidence: 99%

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

et al. 2001

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“…24 Aortic cross-clamping time. A total of 27 cohorts 10,14,15,17,[21][22][23][24]26,27,[29][30][31][32][34][35][36]40,[47][48][49][50][51] reported results of aortic cross-clamping. Only 11 cohorts provided the variability of the mean aortic clamping time, whereas 2 cohorts (Papadimitriou et al 17 and Segers et al, 15 group A) reported zero aortic clamping time and were not included in the meta-analysis.…”

Section: Group E)mentioning

confidence: 99%

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Manolesou

Papaioannou

Georgiopoulos

et al. 2019

Journal of Vascular Surgery

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Objective: One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.Methods: An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018.Results: A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I 2 ¼ 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases.Conclusions: Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.

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Replacement of the thoracic aorta with intraluminal sutureless prosthesis

Berger

Karlson

Dunton

et al. 1992

The Annals of Thoracic Surgery

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Use of an Intraluminal Double-ring Vascular Prosthesis in Thoracic Aorta Reconstruction

Cited by 4 publications

References 1 publication

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

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

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Replacement of the thoracic aorta with intraluminal sutureless prosthesis

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