Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis

Abstract

Surgical therapy for dissection of the thoracic aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. A method of treatment with an intraluminal prosthesis that requires no end-to-end anastomosis has been developed. We have used this method in 14 patients, of whom eight had acute thoracic aortic dissections and six had chronic dissections. We assembled our own prosthesis in the first five cases but, more recently, we have utilized an intraluminal prosthesis provided by USCI. Eight of the patients had type 1 dissection, of whom five required concomitant aortic valve replacement and three coronary artery bypass grafting; one had a type II dissection and five had type III dissections. The age range was 31 to 71 years with a mean of 58. There were 12 men and 2 women. There were no intraoperative deaths, but one patient died 10 days postoperatively of a perforated ulcer and another died at 6 months of empyema. Follow-up has been from 9 to 51 months with a mean of 22 months. There has been no evidence of compromise of the aortic lumen and no prosthetic problems, such as erosion, migration, or thrombosis. This technique provides a safe and simple way to repair dissecting aneurysms of the thoracic aorta and has provided long-term reliability. We have subsequently used this graft for 11 patients with aneurysm of the aorta with favorable results. We presently recommend this technique for dissecting, atherosclerotic, and Marfanoid aneurysms of the thoracic aorta.