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Ann Thorac Surg 1991;52:745-749
© 1991 The Society of Thoracic Surgeons
Thoracic and Cardiovascular Surgery Unit, Centre Hospitalier Universitaire Hôpital Saint Eloi, and Laboratoire de Physiologie Cardio-Vasculaire, Institut de Biologie, Bd Henri IV, Montpellier, France
* Address reprint requests to Dr Séguin, Thoracic and Cardiovascular Surgery, CHU Hôpital Saint Eloi, 34059 Montpellier Cedex, France.
From January 1984 to July 1990, 63 patients were operated on for type A acute aortic dissection. Forty-two patients (aged 22 to 80 years) had isolated replacement of the ascending aorta with the following techniques: group 1 (n = 10) had replacement of the ascending aorta with an intraluminal sutureless graft, group 2 (n = 14) had a Dacron prosthesis sutured to the aorta, and in group 3 (n = 18) the proximal and distal aortic stumps were glued together and reinforced at the suture sites with fibrin sealant before implantation of the Dacron prosthesis. There were no significant differences between the three groups with respect to age, sex, or preoperative clinical and anatomical data. Three (30%) intraoperative deaths occurred in group 1, 4 (29%) in group 2, and none in group 3. Cross-clamp and extracorporeal circulation time were significantly lower in group 1 when compared with groups 2 and 3. Perioperative blood loss during the first 24 hours was significantly lower in group 3 (372 ± 155 mL) when compared with group 1 (755 ± 210 mL; p < 0.05) or group 2 (1,055 ± 370 mL; p < 0.01). Total hospital mortality was 7 (70%) in group 1, 6 (43%) in group 2, and 1 (5.5%) in group 3. All patients were reviewed: one late death occurred in group 2 and none in the other groups. All survivors were in good clinical condition. In conclusion, intraluminal sutureless grafts allowed shorter cross-clamp and extracorporeal circulation time but did not improve surgical results for treatment of type A acute aortic dissections. The use of fibrin sealant reduced perioperative deaths, perioperative bleeding, and in-hospital mortality and improved results of operation for acute aortic dissections.
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