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Ann Thorac Surg 1990;50:74-79
© 1990 The Society of Thoracic Surgeons

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Articles

Sutureless ring graft replacement of ascending aorta and aortic arch

^a Department of Surgery, The Medical Center of Delaware, Wilmington, Delaware USA
^b Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York USA

Accepted for publication January 29, 1990.

^_* Address reprint requests to Dr Oz, Department of Surgery, box 170, Columbia-Presbyterian Medical Center, 622 W 168th St, New York, NY 10032.

Complications after aortic replacement that result from prolonged graft insertion time and technical difficulties with suturing through friable, diseased aortic tissue can be addressed with use of the sutureless intraluminal ring graft. Between 1978 and 1989, we replaced the ascending aorta or aortic arch with this device in 49 patients. At no time were we unable to use a sutureless graft during a procedure. Twenty-eight cases of aneurysmal disease and 21 cases of acute or chronic dissection were treated. Twenty-six patients required replacement of the aortic valve, with annuloaortic ectasia being the most common indication (71%). Ten patients underwent concomitant coronary artery bypass grafting. The operative mortality rate for ascending aortic aneurysm repairs was 4%, and that for dissections was 18%. Five of 8 patients requiring aortic arch replacement survived. Most patients were studied angiographically before discharge. No complications were related to anastomotic hemorrhage, pseudoaneurysm formation, graft migration, or thromboemboli. Individual cases of phrenic nerve palsy, acute tubular necrosis, and transient ischemic attack, all of which resolved completely, were identified. The actuarial 5-year survival rate is 64%. We conclude that modification of the sutureless intraluminal ring graft to suit the pathology encountered at operation allows the quickest repair with the least chance of anastomotic complication.

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