Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Xuezhi ,  GAO Feng , GAO Yang , SHI Lei , ZHUANG Xijing , LIU Wei , WANG Wenjun , SHI Zepeng

Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, 116033, Liaoning, P. R. China;

Corresponding author：

GAO Feng, Email: comeongaofeng@aliyun.com

Keywords：

Adventitial inversion; eversion anastomosis; aortic dissection; aortic root; surgery

DOI：

10.7507/1007-4848.202009087

Video：

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Objective To evaluate the short-term therapeutic effect of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection (ATAAD).Methods From November 2019 to July 2020, 28 patients with ATAAD were treated by extended adventitial inversion with graft eversion anastomosis technique in the Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, including 19 males and 9 females, aged 60.11±11.11 years. The intima of the ascending aorta was trimed to 5 mm above the sinotubular junction. The adventitia of the ascending aorta was longitudinally cut to the reserved intima margin along the junction of the three aortic valves. The extended adventitial inversion was sutured continuously, no coronary sinus was sutured over the aortic annulus, and the left and right coronary sinus was sutured above the coronary ostium. The anastomotic graft was everted and inserted into the aortic lumen, and the everted graft was continuously sutured at the level of sinotubular junction which was 5 mm away from the edge of graft.Results There was no intraoperative death, intractable root hemorrhage, residual root false lumen, root dilatation, anastomotic hematoma or other complications. There was no recurrence of the pain in the back of all patients, and the results of the CT angiography were not significantly changed. In 22 patients with no regurgitation, only 1 (4.55%) patient had a mild regurgitation. In 6 patients with mild aortic regurgitation, the disappearance rate of regurgitation was 50.0% (3/6).Conclusion The treatment of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of aortic dissection eliminates the residual dissection at the root. The anastomotic hemorrhage is prevented, the root structure of aortic dissection is reconstructed and strengthened, the root function is restored, and the possible expansion of the root is prevented. The short-term results are satisfactory.

Citation： HE Xuezhi, GAO Feng, GAO Yang, SHI Lei, ZHUANG Xijing, LIU Wei, WANG Wenjun, SHI Zepeng. Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 371-376. doi: 10.7507/1007-4848.202009087 Copy

1.	Ullery BW, Suh GY, Hirotsu K, et al. Geometric deformations of the thoracic aorta and supra-aortic arch branch vessels following thoracic endovascular aortic repair. Vasc Endovascular Surg, 2018, 52(3): 173-180.
2.	Yunoki J, Nakayama Y, Oonishi H, et al. Partial aortic root remodeling with an adventitial inversion technique for an acute type A aortic dissection. J Card Surg, 2010, 25(3): 327-329.
3.	Qiu J, Wu J, Xie E, et al. Surgical management and outcomes of the aortic root in acute type A aortic dissection. Ann Thorac Surg, 2020, 110(1): 136-143.
4.	Immer FF, Hagen U, Berdat PA, et al. Risk factors for secondary dilatation of the aorta after acute type A aortic dissection. Eur J Cardiothorac Surg, 2005, 27(4): 654-657.
5.	Suzuki S, Masuda M. An update on surgery for acute type A aortic dissection: Aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39(4): 281-289.
6.	Ma WG, Ziganshin BA, Guo CF, et al. Does BioGlue contribute to anastomotic pseudoaneurysm after thoracic aortic surgery? J Thorac Dis, 2017, 9(8): 2491-2497.
7.	De Somer F. Understanding the delicate balance between bleeding and thrombosis: Can we use it to our advantage? J Extra Corpor Technol, 2012, 44(1): 13-15.
8.	Vuocolo T, Haddad R, Edwards GA, et al. A highly elastic and adhesive gelatin tissue sealant for gastrointestinal surgery and colon anastomosis. J Gastrointest Surg, 2012, 16(4): 744-752.
9.	Singh A, Wyatt M, Clarke M, et al. Late sterile abscess formation in carotid endarterectomy following use of BioGlue: A word of caution. EJVES Short Rep, 2017, 37: 12-13.
10.	Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
11.	Slezak P, Klang A, Ferguson J, et al. Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model. J Biomater Appl, 2020, 34(9): 1330-1340.
12.	Floten HS, Ravichandran PS, Furnary AP, et al. Adventitial inversion technique in repair of aortic dissection. Ann Thorac Surg, 1995, 59(3): 771-772.
13.	Koshiyama H, Okubo S, Futagami D, et al. Adventitial wrap technique for acute type A aortic dissection. Ann Thorac Surg, 2018, 106(6): e329-e331.
14.	Shimamura J, Yamamoto S, Oshima S, et al. Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute type A aortic dissection. Eur J Cardiothorac Surg, 2018, 54(2): 369-374.
15.	Sako H, Tanaka H, Morita M, et al. Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: Reverse stepwise anastomosis. Gen Thorac Cardiovasc Surg, 2018, 66(8): 492-494.
16.	Tamura N, Komiya T, Sakaguchi G, et al. 'Turn-up' anastomotic technique for acute aortic dissection. Eur J Cardiothorac Surg, 2007, 31(3): 548-549.
17.	Yang B, Norton EL, Hobbs R, et al. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J Thorac Cardiovasc Surg, 2019, 157(6): 2125-2136.
18.	陈伟丹, 常谦, 李守军, 等. 保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析. 中国胸心血管外科临床杂志, 2012, 19(5): 498-501.
19.	魏波, 于存涛, 孙晓刚, 等. 保留主动脉瓣的主动脉根部替换手术临床疗效分析. 中华实用诊断与治疗杂志, 2014, 28(5): 463-464.
20.	Yamanaka K, Hori Y, Ikarashi J, et al. Durability of aortic valve preservation with root reconstruction for acute type A aortic dissection. Eur J Cardiothorac Surg, 2012, 41(4): e32-e36.
21.	Qin J, Zhao Z, Wang R, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair. J Am Heart Assoc, 2017, 6(4): e004542.
22.	Ohata T, Miyamoto Y, Mitsuno M, et al. Modified sandwich technique for acute aortic dissection. Asian Cardiovasc Thorac Ann, 2007, 15(3): 261-263.
23.	Marty B. Reinforcing the anastomotic cuff in aortic dissection. Eur J Cardiothorac Surg, 2005, 28(6): 869-870.
24.	Rylski B, Siepe M, Schoellhorn J, et al. An improved technique for aortic anastomosis: Graft telescopic inversion. J Thorac Cardiovasc Surg, 2010, 140(4): 934-935.
25.	Tanaka K, Morioka K, Li W, et al. Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection. Eur J Cardiothorac Surg, 2005, 28(6): 864-869.

1. Ullery BW, Suh GY, Hirotsu K, et al. Geometric deformations of the thoracic aorta and supra-aortic arch branch vessels following thoracic endovascular aortic repair. Vasc Endovascular Surg, 2018, 52(3): 173-180.
2. Yunoki J, Nakayama Y, Oonishi H, et al. Partial aortic root remodeling with an adventitial inversion technique for an acute type A aortic dissection. J Card Surg, 2010, 25(3): 327-329.
3. Qiu J, Wu J, Xie E, et al. Surgical management and outcomes of the aortic root in acute type A aortic dissection. Ann Thorac Surg, 2020, 110(1): 136-143.
4. Immer FF, Hagen U, Berdat PA, et al. Risk factors for secondary dilatation of the aorta after acute type A aortic dissection. Eur J Cardiothorac Surg, 2005, 27(4): 654-657.
5. Suzuki S, Masuda M. An update on surgery for acute type A aortic dissection: Aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39(4): 281-289.
6. Ma WG, Ziganshin BA, Guo CF, et al. Does BioGlue contribute to anastomotic pseudoaneurysm after thoracic aortic surgery? J Thorac Dis, 2017, 9(8): 2491-2497.
7. De Somer F. Understanding the delicate balance between bleeding and thrombosis: Can we use it to our advantage? J Extra Corpor Technol, 2012, 44(1): 13-15.
8. Vuocolo T, Haddad R, Edwards GA, et al. A highly elastic and adhesive gelatin tissue sealant for gastrointestinal surgery and colon anastomosis. J Gastrointest Surg, 2012, 16(4): 744-752.
9. Singh A, Wyatt M, Clarke M, et al. Late sterile abscess formation in carotid endarterectomy following use of BioGlue: A word of caution. EJVES Short Rep, 2017, 37: 12-13.
10. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
11. Slezak P, Klang A, Ferguson J, et al. Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model. J Biomater Appl, 2020, 34(9): 1330-1340.
12. Floten HS, Ravichandran PS, Furnary AP, et al. Adventitial inversion technique in repair of aortic dissection. Ann Thorac Surg, 1995, 59(3): 771-772.
13. Koshiyama H, Okubo S, Futagami D, et al. Adventitial wrap technique for acute type A aortic dissection. Ann Thorac Surg, 2018, 106(6): e329-e331.
14. Shimamura J, Yamamoto S, Oshima S, et al. Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute type A aortic dissection. Eur J Cardiothorac Surg, 2018, 54(2): 369-374.
15. Sako H, Tanaka H, Morita M, et al. Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: Reverse stepwise anastomosis. Gen Thorac Cardiovasc Surg, 2018, 66(8): 492-494.
16. Tamura N, Komiya T, Sakaguchi G, et al. 'Turn-up' anastomotic technique for acute aortic dissection. Eur J Cardiothorac Surg, 2007, 31(3): 548-549.
17. Yang B, Norton EL, Hobbs R, et al. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J Thorac Cardiovasc Surg, 2019, 157(6): 2125-2136.
18. 陈伟丹, 常谦, 李守军, 等. 保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析. 中国胸心血管外科临床杂志, 2012, 19(5): 498-501.
19. 魏波, 于存涛, 孙晓刚, 等. 保留主动脉瓣的主动脉根部替换手术临床疗效分析. 中华实用诊断与治疗杂志, 2014, 28(5): 463-464.
20. Yamanaka K, Hori Y, Ikarashi J, et al. Durability of aortic valve preservation with root reconstruction for acute type A aortic dissection. Eur J Cardiothorac Surg, 2012, 41(4): e32-e36.
21. Qin J, Zhao Z, Wang R, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair. J Am Heart Assoc, 2017, 6(4): e004542.
22. Ohata T, Miyamoto Y, Mitsuno M, et al. Modified sandwich technique for acute aortic dissection. Asian Cardiovasc Thorac Ann, 2007, 15(3): 261-263.
23. Marty B. Reinforcing the anastomotic cuff in aortic dissection. Eur J Cardiothorac Surg, 2005, 28(6): 869-870.
24. Rylski B, Siepe M, Schoellhorn J, et al. An improved technique for aortic anastomosis: Graft telescopic inversion. J Thorac Cardiovasc Surg, 2010, 140(4): 934-935.
25. Tanaka K, Morioka K, Li W, et al. Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection. Eur J Cardiothorac Surg, 2005, 28(6): 864-869.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection

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