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Eur J Cardiothorac Surg 2006;30:199
© 2006 Elsevier Science NL

Letter to the Editor

Which suture technique is better in acute type A aortic dissection?

Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey

Received 17 March 2006; accepted 4 April 2006.

^_* Corresponding author. Address: Merdivenkoy Mah. Sairarsi Cad. Emincinarpasa Sok. No: 6/24 34732 Goztepe/Kadikoy, Istanbul, Turkey. Tel.: +90 216 360 0272; fax: +90 216 360 0272. (Email: drmates{at}yahoo.com).

Key Words: Acute aortic dissection • Suture technique

I read with interest a recent article by Santini et al. [1] who have analyzed survival and quality of acute type A dissection in elderly patients. I congratulate them for this article and would like to add few comments.

A patient with an acute type A aortic dissection requires emergent surgical treatment to prevent the expected sequelae of ascending aortic rupture with cardiac tamponade, acute aortic regurgitation caused by loss of leaflet commissural suspension, myocardial infarction caused by coronary artery compromise, or infarction of distal end organs due to malperfusion. The symptoms of aortic dissection may mimic myocardial ischemia, and physical findings in aortic dissection may be absent or, if present, could be suggestive of a diverse range of other conditions. The mortality rate for patients with untreated proximal aortic dissections has been reported to increase by 1–3% per hour after presentation and is approximately 25% during the first 24 h after the initial presentation, 70% during the first week, and 80% at 2 weeks [2]. Therefore, early diagnosis and suspicion of dissection-blade time period is very important in these patients and recently this period is lower than 1 h in our clinic.

Safi et al. [3] and Coselli et al. [4] prefer separated pledgetted suture instead of long teflon felt for suturing aortic tissue. We also prefer this method. In this technique, the site of bleeding in anastomotic area is easily observed. After changing of our suture technique, bleeding ratio due to anastomosis decreased dramatically.

I agree with authors for preferring resuspension of aorta instead of aortic valve replacement. Recently so many cardiovascular surgeons prefer aortic resuspension sutures for aortic insufficiency due to aortic dissection in acute type A aortic dissection operation except if the valve is destroyed by the dissection, significant preexisting valve pathology and indication for root replacement (annulo-aortic ectasia or Marfan syndrome) [5].

References

1. Santini F, Montalbano G, Messina A, D’Onofrio A, Casali G, Viscardi F, Luciani GB, Mazzucco A. Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention. Eur J Cardiothorac Surg 2006;29:386-391.[Abstract/Free Full Text]
2. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. J Am Med Assoc 2000;283:897-903.[Abstract/Free Full Text]
3. Safi HJ, Miller III CC, Reardon MJ, Iliopoulos DC, Letsou GV, Espada R, Baldwin JC. Operation for acute and chronic aortic dissection: recent outcome with regard to neurologic deficit and early death. Ann Thorac Surg 1998;66:402-411.[Abstract/Free Full Text]
4. Coselli JS, LeMaire SA, Koksoy C. Thoracic aortic anastomosis operative techniques. J Thorac Cardiovasc Surg 2000;5:259-276.
5. Elefteriades JA. What operation for acute type A dissection?. J Thorac Cardiovasc Surg 2002;123:201-203.[Free Full Text]

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				M. Ates and A. U. Gullu Which is more appropriate for right axillary artery cannulation in acute type A aortic dissection -- directly or with graft? Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 815 - 816. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mehmet Ates Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ates, M. Search for Related Content PubMed PubMed Citation Articles by Ates, M. Related Collections Great vessels