Eur J Cardiothorac Surg 2007;31:548-549. doi:10.1016/j.ejcts.2006.11.059
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
‘Turn-up’ anastomotic technique for acute aortic dissection
Nobushige Tamura*,
Tatsuhiko Komiya,
Genichi Sakaguchi,
Taira Kobayashi
Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama 710-8602, Japan
Received 31 July 2006;
received in revised form 9 November 2006;
accepted 15 November 2006.
* Corresponding author. Tel.: +81 86 448 1111; fax: +81 86 421 3424. (Email: nt8167{at}kchnet.or.jp).
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Abstract
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We report a new anastomotic ‘turn-up’ technique in the surgery for acute aortic dissection. This technique includes eversion of the ends of the graft which allows excellent cross-sectional exposure of the aorta and the graft. In our experiences of consecutive 30 cases, this technique reduced perioperative bleeding and resulted in satisfactory clinical outcomes.
Key Words: Anastomosis • Aortic dissection • Surgery • Suture
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1. Introduction
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Although various techniques have been advocated in the surgical treatment for acute aortic dissection, hemostasis at anastomotic sites is still a difficult part of the surgery [1-2]. We began using the ‘turn-up’ technique which involved eversion of the graft at both proximal and distal ends for acute type A dissection since February 2003. Consecutive 30 patients underwent emergent operation with this technique safely.
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2. Technique
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Open distal anastomosis was performed at 25–28 °C with ante-grade selective cerebral perfusion. ‘Turn-up’ anastomosis was performed by the following methods. After trimming the end of the aorta, 6–8 U-stay sutures were placed between the graft and the aorta with reinforcement by a felt strip on the external border of the aortic wall (Fig. 1
). The U-stay sutures were tied down with everting the end of the graft (Fig. 1). Excellent cross-sectional exposure of the aortic wall layer and the graft was obtained and continuous 4-0 polypropylene sutures could be easily added to complete the anastomosis (Fig. 2
). Proximal anastomosis was performed in the same method. This turn-up method was used in consecutive 30 patients of acute aortic dissection. There was no hospital mortality and one case of re-exploration for bleeding.
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Fig. 1. (A) Six to eight U-stay sutures were placed between the graft and the aorta. (B) The U-stay sutures can be easily tied down with everting the end of the graft. (C) Continuous 4-0 polypropylene sutures were added to complete the anastomosis.
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3. Comment
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We had been using a conventional anastomotic technique (single continuous suture with an external felt strip) to treat acute aortic dissection before 2003. After several efforts to decrease bleeding at anastomotic sites, we began using the turn-up technique since 2003. In the first several cases, 12–14 U-stay sutures were placed for everting the end of the grafts. However, as recognizing that the significance of the U-stay sutures was not hemostasis, but eversion of the end of the graft for good cross-sectional exposure of the aortic layer and graft, we decrease the number of the U-stay sutures. Six to eight U-stay sutures might be enough for everting the ends of the graft.
In addition to easiness of the following continuous suturing, the cross-sectional exposure enables it easy to find bleeding points and put additional stitches for hemostasis.
Unlike elephant trunk technique or other techniques, the turn-up technique can be applicable to both proximal and distal ends [3–5].
This technique is similar to the ‘cuffed anastomosis’ which was used in the distal anastomosis for distal aortic aneurysm [3]. We also have been using the turn-up technique for distal aortic aneurysm in 42 cases and aortic root remodeling surgery in 8 cases since 2003. The clinical results were also satisfactory (operative mortality: 0%, re-exploration for bleeding: 0%).
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References
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- Tanaka K, Morioka K, Li W, Yamada N, Takamori A, Handa M, Tanabe S, Ihara A. Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection. Eur J Cardiothorac Surg 2005;28(6):864-869.[Abstract/Free Full Text]
- Oda K, Akimoto H, Hata M, Akasaka J, Yamaya K, Iguchi A, Tabayashi K. Use of cuffed anastomosis in total aortic arch replacement. Ann Thorac Surg 2003;76(3):952-953.[Abstract/Free Full Text]
- Yoshitatsu M, Nomura F, Toda K, Katayama A, Tamura K, Katayama K, Ihara K. The ‘eaves’ technique for distal anastomosis in aortic arch replacement. Ann Thorac Surg 2005;79(4):1422-1424.[Abstract/Free Full Text]
- Sakamoto T, Yoshida T, Sugano T, Kudoh A, Susuki A. Simplified technique for hemi-arch replacement during open distal anastomosis: the ‘calla’ method. Ann Thorac Surg 1996;61(3):1021-1023.[Abstract/Free Full Text]
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Abstract
1. Introduction
