Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation

Nguyen, B.; Müller, M.; Kipfer, B.; Berdat, P.; Walpoth, B.; Althaus, U.; Carrel, T. (1999). Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation. European journal of cardio-thoracic surgery, 15(4), pp. 496-501. Elsevier Science B.V. 10.1016/S1010-7940(99)00036-6

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Objective: To compare three different techniques of distal aortic repair in acute type A (de Bakey type I) aortic dissection and to evaluate their impact on the late morphology of the aortic arch and descending aorta and on the incidence of reoperation. Methods: From 65 patients operated on due to an acute type A aortic dissection between 1989 and 1993, 54 long-term survivors underwent clinical and radiologic follow-up examination after a mean postoperative interval of 62±16 months. The surgical techniques of distal aortic reconstruction included closed repair using Teflon felt reinforcement under moderate hypothermic cardiopulmonary bypass (n=20) and open repair in deep hypothermic circulatory arrest using either Teflon felt reinforcement (n=16) or gelatin-resorcin-formaldehyde (GRF) glue (n=18) to readapt the dissected aortic layers. In all patients, MR imaging was performed on a 1.5-T whole body imaging system for the evaluation of the morphology and function of the heart, aorta and supraaortic branches. Results: Overall hospital mortality following surgical repair of type A aortic dissection was 15.4% during this time period. The highest rate of persistent false lumen perfusion (17/20, 85%) and presence of an intimal flap in the aortic arch (13/20, 65%) was observed in patients following closed repair of acute ascending aortic dissection, whereas the lowest rate of such findings was demonstrated in patients who had undergone open distal aortic repair using biological glue (false lumen perfusion 10/18, 55% and intimal flap in the arch 2/18, 11%). Redo-surgery was significantly reduced in the open repair group using GRF glue (1/18, 5.5%) as compared with the Teflon felt repair group (3/16, 18%) and the closed repair group (6/20, 30%). Conclusions: In patients with acute type A dissection, open distal aortic repair using GRF-glue favourably influences both (1) the severity of late morphologic alterations in the downstream aorta and (2) the incidence of reoperation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Berdat, Pascal; Althaus, Ulrich and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1010-7940

Publisher:

Elsevier Science B.V.

Language:

English

Submitter:

Marceline Brodmann

Date Deposited:

05 Oct 2020 15:28

Last Modified:

05 Oct 2020 15:28

Publisher DOI:

10.1016/S1010-7940(99)00036-6

BORIS DOI:

10.7892/boris.115607

URI:

https://boris.unibe.ch/id/eprint/115607

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