Repair of the Aortic dissection with surgical glue.
P Menu, T Sais, P Corbi, M Rahmati, C Jayle , JM Charrière
• Since glue was first introduced in 1974 for acute type A aortic dissection, several
innovative approaches have been proposed
• About cerebral protection
• About extensed cross reparation
• About distal anastomosis (open or clamped)
• About proximal reparation (Yacoub-David)
The aim of this study were to examine the improvement from these new technics
Introduction
Material and methods
• From 1991 to 2001, 58 consecutives
patients underwent emergency repair for acute type A aortic dissection
• 42 men and 16 women
• Aged from 41 to 85 mean 65.2+-11
Hypothermic circulatory arrest and open technics 58 consecutive patients (42 M,16F) mean age 65.2+-11
10 patients
+CABG
Moderate Hypothemy Clamped technics
distal and proximal engluing
48 Patients
39
6
1
2 AA+Yacoub-
David
6
2
2
Cold Cerebroblegia A new technique of
cerebral protection during operation on the transverse aortic
arch
J Bachet JTCS 1991;102:85-94
The open Technic
Circulatory arrest in the main circuit
Should the arch be included?
When
Why ?
How ?
When ?
• Intimal tear in the cross
• Intimal tear not found in the ascending aorta
• Young patient or Marfan ?
• Massive False lumen> thrue lumen ?
T Kazui, JTCS 2000;119:558--65
Why ?
• Reoperation more frequent (Bachet)
• « At the emergency procedure, all
patients with Marfan’s disease have a total aortic root replacement »
• J Bachet JTCS 1994;108: 206
Entre 1977 et 1992, 143 pts ont été opérés pour dissection de type A , 42 pts avec crosse.
Sur les 18 Marfan sans extension à la première intervention 7 patients ont été réopérés
Sur les 30 opérés avec extension 0 réopération
• « L’extension de la reconstruction à la crosse réduit le risque de réopération »
Le développement de nouvelles techniques de protection encéphalique a considérablement réduit l’augmentation du risque opératoire et peut le neutraliser
Should the arch be included?
E Crawford JTCS 1992-104;46-59
How ? Open technic
Cold cerbroplegia
Retrograde cerebral perfusion
during hypothermic circulatory arrest reduces neurologic morbidity
M Deeb JTCS 1995;109259-68
Réoperation: Poitiers 1991-1999
• 5 patients 46.2+/-11 (32-54)
Proximal problem 4 dilatations Distal problem 1
Conclusion
• Our experience suggest that open techniques and fibrin glue for distal anastomosis repair
• And anatomical reconstruction inspired by M Yacoub without glue for proximal repair
improve the early and late outcomes of surgery for type A dissection of the aorta
