Plaster technique for filling up a future entry at the suture hole in type A aortic dissection

Abstract

Although the surgical technique for acute type A aortic dissection dramatically improved in recent years, the postoperative mortality and morbidity rates remain high. After the emergency surgery for acute type A aortic dissection, a small tear in the aorta may result in dilation of the false lumen in the future. Some tears originate from the suture line on the anastomosis. This report introduces the novel "plaster technique" that involves using a single interrupted suture with felt and plastering a minimum dose of BioGlue into the suture hole. Similar to patients with acute aortic dissection, we found that the plaster technique using a felt pledget and minimum dose of BioGlue is effective for fragile aortic walls. Moreover, it is a simple, safe, and durable technique to strengthen the suture line.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-022-01351-0.

Keywords: Aortic dissection; Suture entry; Suture hole.

Fig. 1

A plaster technique schema. In the image above, we examine the suture line from the inside for any new intimal tears caused by the suture, and to identify the fragile intima. In the image below, a double-arm 4–0 pledgeted polypropylene suture is passed from inside the aortic lumen to the graft externally. BioGlue is applied between the pledget and the intimal layer. The suture is tied gently and the pledget is affixed to the aortic wall to plaster the tear

Fig. 2

Postoperative computed tomography scan demonstrates integrity of the repair at the proximal suture line using the plaster technique