Research progress on aortic root repair by modified sandwich technique for acute Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Chuang , FAN Shuya , SUN Yangxue ,  GUO Hongwei

1. Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

GUO Hongwei, Email: ghwdr@sina.com

Keywords：

Aortic dissection; aortic root repair; modified sandwich technique; aortic sinus; review

DOI：

10.7507/1007-4848.202206034

Video：

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Acute Stanford type A aortic dissection has the characteristics of acute onset, severe condition and high mortality. Once making a definite diagnosis, surgical treatment is needed as soon as possible. It is difficult for cardiac surgeons to treat the acute aortic dissection involving the aortic sinus, which is an important risk factor for death. Improving the surgical treatment for the aortic sinus can be a key to improving the prognosis. In this review, we will introduce the modified sandwich technique for acute Stanford type A aortic dissection and the prognosis, and summarize the experiences of different modified sandwich techniques. However, there is still no unified standardized technique in aortic root repair, and there is a lack of large studies with long-term follow-up, so it is necessary to further improve the aortic root repair techniques.

Citation： LIU Chuang, FAN Shuya, SUN Yangxue, GUO Hongwei. Research progress on aortic root repair by modified sandwich technique for acute Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 478-484. doi: 10.7507/1007-4848.202206034 Copy

1.	Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: Results and predictors of mortality. Ann Cardiothorac Surg, 2016, 5(4): 346-351.
2.	Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection Interventional Cohort Program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
3.	Duan WX, Wang WG, Xia L, et al. Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: Lessons from the first registry of aortic dissection in China. Chin Med J (Engl), 2021, 134(8): 927-934.
4.	Mosbahi S, Stak D, Gravestock I, et al. A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection. Eur J Cardiothorac Surg, 2019, 55(2): 201-209.
5.	Chang Y, Guo H, Qian X, et al. A case report of aortic root repair using a pericardial autograft for type A aortic dissection. J Cardiothorac Surg, 2020, 15(1): 319.
6.	Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.
7.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13): e266-e369.
8.	Yang B, Malik A, Waidley V, et al. Short-term outcomes of a simple and effective approach to aortic root and arch repair in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2018, 155(4): 1360-1370.
9.	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.
10.	Tanaka K, Yamamoto K, Hiraiwa T, et al. Early and mid-term outcomes of surgical treatment with conservative approach using adventitial inversion technique for an acute type A aortic dissection. Kyobu Geka, 2016, 69(4): 257-262.
11.	Motekallemi A, Dell'Aquila AM, Rukosujew A. The modified adventitial inversion technique as an alternative method for aortic repair in acute type A aortic dissection: Balancing complexity and effectiveness. J Thorac Cardiovasc Surg, 2020, 159(2): e103.
12.	Guo HW, Chang Y, Qian XY. Aortic root repair using pericardial autograft for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 161(2): e154.
13.	Rylski B, Bavaria JE, Milewski RK, et al. Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg, 2014, 98(2): 582-588.
14.	Tang Y, Liao Z, Han L, et al. Long-term results of modified sandwich repair of aortic root in 151 patients with acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 25(1): 109-113.
15.	Ro SK, Kim JB, Hwang SK, et al. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg, 2013, 146(5): 1113-1118.
16.	Ellauzi H, Zafar MA, Wu J, et al. Fate of preserved aortic root following acute type A aortic dissection repair. Semin Thorac Cardiovasc Surg, 2022, 34(2): 419-427.
17.	Ohno N, Minatoya K. Reinforcement and reapproximation of the aortic stump during surgery for acute aortic dissection. Surg Today, 2019, 49(8): 645-648.
18.	魏柯, 郭宏伟. 急性StanfordA型主动脉夹层手术端端血管吻合技术的最新进展. 中国胸心血管外科临床杂志, 2018, 25(12): 1085-1090.
19.	Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation, 1990, 82(5 Suppl): 24-38.
20.	Matsuura K, Ogino H, Minatoya K, et al. Aortic stenosis caused by the felt strip used in repair for acute aortic dissection. Interact Cardiovasc Thorac Surg, 2004, 3(1): 41-43.
21.	Sogawa M, Moro H, Namura O, et al. Thrombus on the intraluminal felt strip. A possible cause of postoperative stroke. Jpn J Thorac Cardiovasc Surg, 2001, 49(5): 333-335.
22.	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.
23.	Floten HS, Ravichandran PS, Furnary AP, et al. Adventitial inversion technique in repair of aortic dissection. Ann Thorac Surg, 1995, 59(3): 771-772.
24.	Zhu C, Piao H, Wang Y, et al. A new aortic root reinforcement technique for acute type A aortic dissection surgery. Int Heart J, 2019, 60(5): 1131-1136.
25.	Piao H, Wang Y, Huang M, et al. Outcomes of Liu's aortic root repair and valve preservation in patients with type A dissection and aortic regurgitation. Interact Cardiovasc Thorac Surg, 2021, 32(5): 781-788.
26.	蒋捷, 顾嘉玺, 刘鸿, 等. “改良三明治”技术在急性A型主动脉夹层中的应用效果. 医学研究生学报, 2022, 35(2): 175-179.
27.	Gaeta R, Lentini S, Tancredi F, et al. Surgery for acute aortic dissection: An easy and cheap method to reinforce the anastomosis. J Card Surg, 2009, 24(2): 173-174.
28.	Chen LW, Wu XJ, Li QZ, et al. A modified valve-sparing aortic root replacement technique for acute type A aortic dissection: The patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4): 731-733.
29.	Chen LW, Dai XF, Wu XJ, et al. Valve-sparing root replacement with root reduction plasty and patch neointima placement. Ann Thorac Surg, 2013, 95(4): 1459-1461.
30.	Dai XF, Fang GH, Yan LL, et al. Patch neointima technique in acute type A aortic dissection: Midterm results of 147 cases. Ann Thorac Surg, 2021, 112(1): 75-82.
31.	Wu Q, Wang Z, Qiu Z, et al. Mid-term outcomes of modified valve-sparing aortic root replacement versus the Bentall procedure for middle-aged Chinese patients with acute DeBakey Ⅰ aortic dissection: A single-center retrospective study. BMC Cardiovasc Disord, 2021, 21(1): 196.
32.	王春生, 李军, 赖颢. StanfordA型主动脉夹层根部重建技术的应用现状与思考. 中华外科杂志, 2017, 55(4): 245-250.
33.	Xue Y, Zhou Q, Pan J, et al. "Double jacket wrapping" root reconstruction for acute type A aortic dissection. Ann Thorac Surg, 2020, 110(3): 1060-1062.
34.	Xue Y, Zhou Q, Pan J, et al. Root reconstruction for proximal repair in acute type A aortic dissection. J Thorac Dis, 2019, 11(11): 4708-4716.
35.	薛云星, 周庆, 潘俊, 等. 双马甲包裹法根部重建技术用于急性A型主动脉夹层的近端修复. 中华胸心血管外科杂志, 2021, 37(4): 212-215.
36.	Moscarelli M, Fattouch K, Speziale G. Tailor-made aortic root reconstruction. Ann Thorac Surg, 2021, 111(3): 1097-1098.
37.	Song L, Gao Y, Xu M, et al. "Sleeve" sinus of valsalva repair in patients with acute type A aortic dissection. Heart Surg Forum, 2021, 24(3): E418-E421.
38.	Inoue Y, Minatoya K, Itonaga T, et al. Utility of proximal stepwise technique for acute aortic dissection involving the aortic root. Ann Thorac Surg, 2016, 101(5): e183-e185.
39.	郭应强, 张尔永, 蒙炜, 等. 急性A型主动脉夹层手术主动脉断端加固方法的改进. 中国胸心血管外科临床杂志, 2009, 16(5): 389-391.
40.	Kan CD, Yang YJ. Double telescopic anastomosis with interrupted suture technique in acute aortic dissection. Ann Thorac Surg, 2011, 91(5): 1630-1631.
41.	Rylski B, Siepe M, Blanke P, et al. Adventitial inversion with graft telescopic insertion for distal anastomosis in acute type A aortic dissection. Ann Thorac Cardiovasc Surg, 2012, 18(3): 278-280.
42.	Wu HY, Kan CD. Modified double telescopic anastomosis with interrupted suture technique. Ann Thorac Surg, 2013, 95(2): 773.
43.	Gocoł R, Bis J, Hudziak D, et al. Aortic root reconstruction with TachoSil fibrin sealant patch in acute type A aortic dissection. Ann Thorac Cardiovasc Surg, 2021, 27(4): 267-272.

1. Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: Results and predictors of mortality. Ann Cardiothorac Surg, 2016, 5(4): 346-351.
2. Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection Interventional Cohort Program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
3. Duan WX, Wang WG, Xia L, et al. Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: Lessons from the first registry of aortic dissection in China. Chin Med J (Engl), 2021, 134(8): 927-934.
4. Mosbahi S, Stak D, Gravestock I, et al. A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection. Eur J Cardiothorac Surg, 2019, 55(2): 201-209.
5. Chang Y, Guo H, Qian X, et al. A case report of aortic root repair using a pericardial autograft for type A aortic dissection. J Cardiothorac Surg, 2020, 15(1): 319.
6. Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758.
7. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 2010, 121(13): e266-e369.
8. Yang B, Malik A, Waidley V, et al. Short-term outcomes of a simple and effective approach to aortic root and arch repair in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2018, 155(4): 1360-1370.
9. 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.
10. Tanaka K, Yamamoto K, Hiraiwa T, et al. Early and mid-term outcomes of surgical treatment with conservative approach using adventitial inversion technique for an acute type A aortic dissection. Kyobu Geka, 2016, 69(4): 257-262.
11. Motekallemi A, Dell'Aquila AM, Rukosujew A. The modified adventitial inversion technique as an alternative method for aortic repair in acute type A aortic dissection: Balancing complexity and effectiveness. J Thorac Cardiovasc Surg, 2020, 159(2): e103.
12. Guo HW, Chang Y, Qian XY. Aortic root repair using pericardial autograft for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2021, 161(2): e154.
13. Rylski B, Bavaria JE, Milewski RK, et al. Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection. Ann Thorac Surg, 2014, 98(2): 582-588.
14. Tang Y, Liao Z, Han L, et al. Long-term results of modified sandwich repair of aortic root in 151 patients with acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 25(1): 109-113.
15. Ro SK, Kim JB, Hwang SK, et al. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: Fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg, 2013, 146(5): 1113-1118.
16. Ellauzi H, Zafar MA, Wu J, et al. Fate of preserved aortic root following acute type A aortic dissection repair. Semin Thorac Cardiovasc Surg, 2022, 34(2): 419-427.
17. Ohno N, Minatoya K. Reinforcement and reapproximation of the aortic stump during surgery for acute aortic dissection. Surg Today, 2019, 49(8): 645-648.
18. 魏柯, 郭宏伟. 急性StanfordA型主动脉夹层手术端端血管吻合技术的最新进展. 中国胸心血管外科临床杂志, 2018, 25(12): 1085-1090.
19. Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation, 1990, 82(5 Suppl): 24-38.
20. Matsuura K, Ogino H, Minatoya K, et al. Aortic stenosis caused by the felt strip used in repair for acute aortic dissection. Interact Cardiovasc Thorac Surg, 2004, 3(1): 41-43.
21. Sogawa M, Moro H, Namura O, et al. Thrombus on the intraluminal felt strip. A possible cause of postoperative stroke. Jpn J Thorac Cardiovasc Surg, 2001, 49(5): 333-335.
22. 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.
23. Floten HS, Ravichandran PS, Furnary AP, et al. Adventitial inversion technique in repair of aortic dissection. Ann Thorac Surg, 1995, 59(3): 771-772.
24. Zhu C, Piao H, Wang Y, et al. A new aortic root reinforcement technique for acute type A aortic dissection surgery. Int Heart J, 2019, 60(5): 1131-1136.
25. Piao H, Wang Y, Huang M, et al. Outcomes of Liu's aortic root repair and valve preservation in patients with type A dissection and aortic regurgitation. Interact Cardiovasc Thorac Surg, 2021, 32(5): 781-788.
26. 蒋捷, 顾嘉玺, 刘鸿, 等. “改良三明治”技术在急性A型主动脉夹层中的应用效果. 医学研究生学报, 2022, 35(2): 175-179.
27. Gaeta R, Lentini S, Tancredi F, et al. Surgery for acute aortic dissection: An easy and cheap method to reinforce the anastomosis. J Card Surg, 2009, 24(2): 173-174.
28. Chen LW, Wu XJ, Li QZ, et al. A modified valve-sparing aortic root replacement technique for acute type A aortic dissection: The patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4): 731-733.
29. Chen LW, Dai XF, Wu XJ, et al. Valve-sparing root replacement with root reduction plasty and patch neointima placement. Ann Thorac Surg, 2013, 95(4): 1459-1461.
30. Dai XF, Fang GH, Yan LL, et al. Patch neointima technique in acute type A aortic dissection: Midterm results of 147 cases. Ann Thorac Surg, 2021, 112(1): 75-82.
31. Wu Q, Wang Z, Qiu Z, et al. Mid-term outcomes of modified valve-sparing aortic root replacement versus the Bentall procedure for middle-aged Chinese patients with acute DeBakey Ⅰ aortic dissection: A single-center retrospective study. BMC Cardiovasc Disord, 2021, 21(1): 196.
32. 王春生, 李军, 赖颢. StanfordA型主动脉夹层根部重建技术的应用现状与思考. 中华外科杂志, 2017, 55(4): 245-250.
33. Xue Y, Zhou Q, Pan J, et al. "Double jacket wrapping" root reconstruction for acute type A aortic dissection. Ann Thorac Surg, 2020, 110(3): 1060-1062.
34. Xue Y, Zhou Q, Pan J, et al. Root reconstruction for proximal repair in acute type A aortic dissection. J Thorac Dis, 2019, 11(11): 4708-4716.
35. 薛云星, 周庆, 潘俊, 等. 双马甲包裹法根部重建技术用于急性A型主动脉夹层的近端修复. 中华胸心血管外科杂志, 2021, 37(4): 212-215.
36. Moscarelli M, Fattouch K, Speziale G. Tailor-made aortic root reconstruction. Ann Thorac Surg, 2021, 111(3): 1097-1098.
37. Song L, Gao Y, Xu M, et al. "Sleeve" sinus of valsalva repair in patients with acute type A aortic dissection. Heart Surg Forum, 2021, 24(3): E418-E421.
38. Inoue Y, Minatoya K, Itonaga T, et al. Utility of proximal stepwise technique for acute aortic dissection involving the aortic root. Ann Thorac Surg, 2016, 101(5): e183-e185.
39. 郭应强, 张尔永, 蒙炜, 等. 急性A型主动脉夹层手术主动脉断端加固方法的改进. 中国胸心血管外科临床杂志, 2009, 16(5): 389-391.
40. Kan CD, Yang YJ. Double telescopic anastomosis with interrupted suture technique in acute aortic dissection. Ann Thorac Surg, 2011, 91(5): 1630-1631.
41. Rylski B, Siepe M, Blanke P, et al. Adventitial inversion with graft telescopic insertion for distal anastomosis in acute type A aortic dissection. Ann Thorac Cardiovasc Surg, 2012, 18(3): 278-280.
42. Wu HY, Kan CD. Modified double telescopic anastomosis with interrupted suture technique. Ann Thorac Surg, 2013, 95(2): 773.
43. Gocoł R, Bis J, Hudziak D, et al. Aortic root reconstruction with TachoSil fibrin sealant patch in acute type A aortic dissection. Ann Thorac Cardiovasc Surg, 2021, 27(4): 267-272.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress on aortic root repair by modified sandwich technique for acute Stanford type A aortic dissection

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