Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the short-term therapeutic effect of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection (ATAAD). Methods    From November 2019 to July 2020, 28 patients with ATAAD were treated by extended adventitial inversion with graft eversion anastomosis technique in the Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, including 19 males and 9 females, aged 60.11±11.11 years. The intima of the ascending aorta was trimed to 5 mm above the sinotubular junction. The adventitia of the ascending aorta was longitudinally cut to the reserved intima margin along the junction of the three aortic valves. The extended adventitial inversion was sutured continuously, no coronary sinus was sutured over the aortic annulus, and the left and right coronary sinus was sutured above the coronary ostium. The anastomotic graft was everted and inserted into the aortic lumen, and the everted graft was continuously sutured at the level of sinotubular junction which was 5 mm away from the edge of graft. Results    There was no intraoperative death, intractable root hemorrhage, residual root false lumen, root dilatation, anastomotic hematoma or other complications. There was no recurrence of the pain in the back of all patients, and the results of the CT angiography were not significantly changed. In 22 patients with no regurgitation, only 1 (4.55%) patient had a mild regurgitation. In 6 patients with mild aortic regurgitation, the disappearance rate of regurgitation was 50.0% (3/6). Conclusion    The treatment of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of aortic dissection eliminates the residual dissection at the root. The anastomotic hemorrhage is prevented, the root structure of aortic dissection is reconstructed and strengthened, the root function is restored, and the possible expansion of the root is prevented. The short-term results are satisfactory.

Application of graft eversion anastomosis technique in aortic surgery / 中华胸心血管外科杂志

Due to the emergence of various treatment methods for aortic diseases, the treatment methods of anastomosis have become diversified.The anastomosis of the graft distal eversion partly inserted into the aorta or graft inversion wholely inserted into the aorta increase the joint area between them, and it obviously reduces the impact of tidal blood flow and the lateral force on the anastomosis.Therefore, it has the outstanding advantages of reducing the risk of hemorrhage after anastomosis, simplifying the intraoperative suture operation and easy treatment of anastomotic hemorrhage.Similar techniques with different names are often used in the surgical treatment of aortic lesions and have achieved good anastomosis.In this paper, the concept is uniformly referred to as " Graft Eversion Anastomosis Technique" , and its application evolution in aortic surgery is systematically expounded, so as to further deepen the understanding of the technology.