Abstract
Although the surgical technique for acute type A aortic dissection dramatically improved in recent years, the postoperative mortality and morbidity rates remain high. After the emergency surgery for acute type A aortic dissection, a small tear in the aorta may result in dilation of the false lumen in the future. Some tears originate from the suture line on the anastomosis. This report introduces the novel “plaster technique” that involves using a single interrupted suture with felt and plastering a minimum dose of BioGlue into the suture hole. Similar to patients with acute aortic dissection, we found that the plaster technique using a felt pledget and minimum dose of BioGlue is effective for fragile aortic walls. Moreover, it is a simple, safe, and durable technique to strengthen the suture line.
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Institutional review board approval was exempt at our institution for this retrospective technique report.
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The turn up anastomosis for the proximal side during the ascending aortic dissection. The felt strip is placed outside the aorta, and the turn-upped prosthetic graft is inserted into the lumen. Four everting mattress stitches with 4–0 polypropylene are placed to fix the aortic wall and the prosthetic graft at 90° intervals; running sutures are performed by keeping the same depth of the suture to complete the anastomosis. (MP4 349,929 kb)
The plaster technique for the proximal anastomosis during ascending aortic dissection repair. After the anastomosis, the suture line is examined intraluminally for any new intimal tears caused by the suture, and to identify fragile parts of the intima. Intimal tears are repaired using a double-armed pledgeted 4–0 polypropylene suture. The suture is passed from inside the aortic lumen to the graft externally. In this case, the felt is reinforced with autologous pericardium. BioGlue is injected between the pledget and intimal layer. This technique can strengthen the suture line. Similar to the proximal side, plaster technique is performed in the distal-side anastomosis. This procedure is easy, even in a deep and narrow field. (MP4 311,202 kb)
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Ishida, S., Mutsuga, M., Fujita, T. et al. Plaster technique for filling up a future entry at the suture hole in type A aortic dissection. Indian J Thorac Cardiovasc Surg 38, 339–341 (2022). https://doi.org/10.1007/s12055-022-01351-0
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DOI: https://doi.org/10.1007/s12055-022-01351-0