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Ann Thorac Surg 2003;76:499-502
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

A double patch sandwich technique for surgical repair of acute aortic dissection type A

Tatiana M. Fleck, MDa, Heinz Tschernich, MDb, Martin Grabenwoger, MDa, Doris Hutschala, MDb, Herbert Koinig, MDb, Ernst Wolner, MDa,b, Werner Mohl, MD, PhDa*

a Department of Cardiothoracic Surgery, Vienna, Austria
b Department of Cardiothoracic and Vascular Anaesthesiology, University of Vienna, Vienna, Austria

Accepted for publication February 15, 2003.

* Address reprint requests to Dr Mohl, Department of Cardiothoracic Surgery, AKH Vienna, Leitstelle 20A, Währinger Gürtel 18-20, 1090 Vienna, Austria.
e-mail: werner.mohl{at}univie.ac.at

BACKGROUND: This study compares two groups of patients with acute aortic dissection type A in whom two different techniques of anastomotic reinforcement were used, and evaluates the impact of these two techniques on perioperative blood loss and surgical outcome.

METHODS: One hundred eighty-five consecutive patients with acute aortic dissection type A between 1998 and 2002 were grouped according to the technique utilized for reinforcing the aortic anastomotic site. Group A consisted of 21 patients in whom a novel double patch sandwich technique was used, whereas in group B (164 patients) conventional Teflon felt strips served as reinforcement.

RESULTS: Preoperative profiles were comparable for both groups. Deep hypothermia and circulatory arrest were used in 180 patients (97%). Retrograde cerebral perfusion and retrograde cardioplegia were used in 70 patients (38%). Hospital mortality for the two groups was 4.7% (1 of 21) and 18% (29 out of 164), p < 0.30, respectively. On average 2 versus 6 U of PRBC (p < 0.21), and 3 versus 5 U of FFP (p < 0.004) were given during operation in groups A and B, respectively, and indicates reduced suture line bleeding in group A.

CONCLUSIONS: Modifications in the surgical technique for repair of acute aortic dissection type A, and in anastomotic reinforcement in particular, may lead to substantial reduction of suture line bleeding and diminished blood loss and transfusion requirements, and favorably affects patient outcome. Nevertheless, continued effort is mandatory to further enhance surgical outcome in this patient population.




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