Short Inverted Graft Anastomosis for Proximal Aortic Repair in Acute Type A Aortic Dissection: Technique and Surgical Experiences

Seung ri Kang

Asan Medical Center, Seoul, Korea (South)

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Background

Aortic surgery in the setting of an acute aortic dissection (AD) is a challenging task carrying high risks of anastomosis sites bleeding. In order to efficiently minimize bleeding in the proximal aorta during open repair of ascending aorta, a technique of using inversion of an artificial graft for proximal anastomosis has been utilized.

Methods

From November 2015 through December 2017, a total of 34 patients undergoing ascending aorta repair using the inverted graft anastomosis were reviewed. The proximal repair was conducted during hypothermic induction under mid-ascending aortic clamping in all patients.

Results

Majority (22/34, 64.7%) of the patients underwent surgery due to acute aortic dissection (AD), and the remaining (12/34, 35%) due to ascending aortic aneurysm. Total arch (N=12) or hemiarch (N=22) replacements were combined in all 34 patients. Upper partial sternotomy was used in 4 patients (13.3%). The median cardiopulmonary bypass , aorta cross clamp, total circulatory arrest time (for the hemiarch group), and antegrade cerebral perfusion time (for the total arch group) were 98.5 minutes (range 56-182), 70.5 minutes (range 9-149),  7 minutes (range 4-31), and 24 minutes (range 9-42) respectively. The median time from incision to wound closure was 221 minutes (range 114-372).There was no case of mortality, low cardiac output syndrome, postoperative bleeding, or neurologic deficit. However, 3 patients (15.8%) showed major complications: mediastinitis in 1, coronary insufficiency requiring additional right coronary bypassing in 1 and root pseudo-aneurysm requiring re-exploration for complete root replacement in 1.

Conclusions

The short inverted graft anastomosis technique for proximal aortic repair may be a reasonable option in terms of Time-efficiency and excellent hemostasis in well selected patients.