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. 2022 Jul 9;35(2):ivac185.
doi: 10.1093/icvts/ivac185.

Fate of dissected arch vessels by adventitial inversion technique for acute type A aortic dissection repair

Yuriko Takeuchi  1 , Ryo Suzuki  1 , Hiroshi Kurazumi  1 , Ryosuke Nawata  1 , Toshiki Yokoyama  1 , Sarii Tsubone  1 , Yutaro Matsuno  1 , Akihito Mikamo  1 , Kimikazu Hamano  1
Affiliations

Fate of dissected arch vessels by adventitial inversion technique for acute type A aortic dissection repair

Yuriko Takeuchi et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The adventitial inversion technique is used widely for aortic reconstruction for acute type A aortic dissection, as it easily controls the bleeding at anastomotic sites and closes the patent false lumen. However, this technique for arch vessel reconstruction has not been previously reported. Therefore, we applied the adventitial inversion technique for dissected arch vessel reconstruction to close the patent false lumen.

Methods: Among 57 consecutive patients who underwent emergency surgical treatment for acute type A aortic dissection from July 2006 to July 2012, the adventitial inversion technique for the dissected arch vessels was performed in 26 patients (42 arch vessel stumps). The patency and morphologic change of the false lumen of the arch vessels were evaluated using contrast-enhanced computed tomography.

Results: Overall, 2 hospital deaths were recorded, and the hospital mortality rate was 4%. No postoperative cerebral strokes and reoperations due to bleeding occurred. Follow-up by contrast-enhanced computed tomography was completed in 24 patients (37 stumps) with a mean duration of 99 ± 35 months. The postoperative closure rate of the false lumen after adventitial inversion was 86%, which was higher than when adventitial inversion was not used. No adverse events including stroke occurred during follow-up period.

Conclusions: This technique facilitates the closure of the false lumen of dissected arch vessels and might improve clinical outcomes.

Keywords: Adventitial inversion technique; Aortic arch replacement; Aortic dissection; Arch vessel.

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Figures

Figure 1:
Figure 1:
Details of the patients who had arch vessel dissection.
Figure 2:
Figure 2:
Three types of false lumen evaluated by computed tomography. Representative computed tomography images of patent, obliterated and closed false lumens.
Figure 3:
Figure 3:
The changes in the arch vessel of the false lumens. There were 21 patent and 16 obliterated false lumens preoperatively. Of the 21 patent false lumens, 17 (81%) were closed whereas 4 (19%) remained patent. Of the 16 obliterated false lumens, 15 (94%) were closed whereas 1 (6%) converted to patent in the immediate postoperative period and remained patent in the long-term postoperative period.
Figure 4:
Figure 4:
(A) Cerebral event-free rate of the patients. (B) The postoperative survival rates.
None
See this image and copyright information in PMC

References

    1. Immer FF, Hagen U, Berdat PA, Eckstein FS, Carrel TP.. Risk factors for secondary dilatation of the aorta after acute type A aortic dissection. Eur J Cardiothorac Surg 2005;27:654–71. - PubMed
    1. Moore NR, Parry AJ, Trottman-Dickenson B, Pillai R, Westaby S.. Fate of the native aorta after repair of acute type A dissection: a magnetic resonance imaging study. Heart 1996;75:62–6. - PMC - PubMed
    1. Fattori R, Bacchi-Reggiani L, Bertaccini P, Napoli G, Fusco F, Longo M. et al. Evolution of aortic dissection after surgical repair. Am J Cardiol 2000;86:868–72. - PubMed
    1. Bernard Y, Zimmermann H, Chocron S, Litzler JF, Kastler B, Etievent JP. et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol 2001;87:1378–82. - PubMed
    1. Driever R, Botsios S, Schmitz E, Donovan J, Vetter HO.. Long-term effectiveness of operative procedures for Stanford type A aortic dissections. Cardiovasc Surg 2003;11:265–72. - PubMed

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