Intimal‐protected adventitial inversion technique accelerates the obliteration of a patent false lumen. Issue 9 (30th June 2022)

• Record Type: Journal Article
• Authors: Suzuki, Ryo; Kurazumi, Hiroshi; Nawata, Ryosuke; Yokoyama, Toshiki; Tsubone, Sarii; Matsuno, Yutaro; Shirasawa, Bungo; Mikamo, Akihito; Hamano, Kimikazu
• Is Part Of: Journal of cardiac surgery. Volume 37:Issue 9(2022)
• Page Start: 2600
• Page End: 2606
• Publication Date: 2022-06-30
• Subjects: adventitial inversion technique -- aorta and great vessels -- extended total aortic arch replacement -- obliterated; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.16720
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and Aims: The optimal procedure for reconstructing the dissected aortic stump for acute type A dissection remains controversial. We routinely used the intimal‐protected adventitial inversion technique (iPAIT), a modified adventitial inversion technique, to protect the fragile intima by inserting a graft and assessed the safety and efficacy of this technique. Methods: Between August 2008 and April 2020, 146 consecutive patients with acute type A dissections underwent thoracic aortic surgery in our hospital. Extended total aortic arch replacement was performed in 119 patients (81.5%). Sixty‐nine patients underwent treatment for distal aortic anastomosis with the iPAIT. To compare the iPAIT to a historical control, we assessed 69 iPAIT patients and 25 patients who underwent total arch replacement using gelatin‐resorcinol‐formaldehyde (GRF) glue. Results: Hospital mortality was 2.9% in the iPAIT group and 8.0% in the GRF group. Perioperative characteristics were similar between the two groups. However, postoperative computed tomography revealed that the obliteration rate was significantly higher in the iPAIT group (60/66, 90.9%) than in the GRF group (15/23, 65.2%) ( p = .01), not including the patients who had died or developed severe renal dysfunction. The 8‐year aortic event‐free survival rate in the iPAIT group (81.3%) was significantly higher than that in the GRF group (47.4%). Conclusions: The use of this technique for acute type A dissections resulted in a low mortality rate and demonstrated promising midterm survival and may accelerate the obliteration of a patent false lumen and prevent late aortic events.