Intimal-protected adventitial inversion technique accelerates the obliteration of a patent false lumen

"Modified sandwich" technique in the surgery of acute type A aortic dissection

BACKGROUND

Acute type A aortic dissection is a rapidly progressive and life-threatening condition. Without timely surgical intervention, the mortality rate can reach up to 50% within the first 48 h. Although surgery remains the primary effective treatment, it is associated with significant complexity and potential risks, particularly in managing the aortic root, where both intraoperative and postoperative bleeding complications are common. This study aims to evaluate the efficacy of the modified "sandwich" technique using a synthetic vascular patch for aortic root reconstruction in acute type A aortic dissection surgery.

METHODS

A retrospective analysis was conducted on the clinical data of 28 patients with acute type A aortic dissection who underwent aortic root reconstruction using the modified "sandwich" technique with synthetic vascular patches at the Department of Cardiovascular Surgery, the Third Hospital of Hebei Medical University, from October 2020 to November 2022. All patients underwent surgical treatment, during which the modified "sandwich" technique was applied for aortic root reconstruction. Statistical analysis was performed on operative time, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, postoperative drainage volume, perioperative mortality, and complications.

RESULTS

All 28 patients underwent successful surgery with a cardiopulmonary bypass (CPB) time of 265.0 (210.0-322.5) min, an aortic cross-clamping (ACC) time of 151.0 (112.0-209.0) min, and a drainage flow rate of 237.5 (126.0-297.0) mL at 12 h postoperatively. There were 2 (7.1%) perioperative deaths caused by renal failure, ischemia in 1 case, and coronary artery causes in 1 case. Postoperative complications included reopening of the chest for hemostasis in 1 case (3.6%) for reasons unrelated to the vascular anastomosis, hemodialysis in 3 cases (10.7%), paraplegia in 1 case (3.6%), and cerebral infarction resulting in impaired mobility of the left upper extremity in 1 case (3.6%). Tracheotomy was performed in 1 case (3.6%), and the duration of mechanical ventilation was 89 (48.0-165) h. Among the 26 recovered patients reviewed with aortic enhancement CT before discharge, the artificial vascular anastomosis had smooth blood flow, though 1 case still had residual entrapment in the sinus of the aorta.

CONCLUSION

In acute type A aortic dissection surgery, the "modified sandwich" technique using an artificial vascular sheet for aortic root shaping is simple, effective, and easy to master. This method can reduce anastomotic blood seepage and prevent anastomotic tear and bleeding, making it worth recommending for clinical application.

A modified adventitial inversion with graft insertion technique in acute Type A aortic dissection

Acute type A aortic dissection may originate from a primary intimal tear located in the ascending aorta and often extends retrogradely into the aortic root. How to prevent bleeding in the aortic root and eliminate false lumen is very important in aortic dissection. We have developed a modified anastomotic technique that involves inverting adventitial and graft into aorta and reinforcing with a felt strip on the external border of the aortic wall. Since 2020, 45 consecutive patients with type A aortic coarctation have undergone this aortic root reconstruction procedure, to date, none have been reopened for bleeding or remnant dissection.

Robust aortic media adhesion using hydrophobically modified Alaska pollock gelatin-based adhesive for aortic dissections

Type-A aortic dissection is an acute injury involving the delamination of the aorta at the parts of the aortic media. Aldehyde crosslinker-containing glues have been used to adhere to the media of the dissected aorta before joining an artificial graft. These glues effectively adhere to the aortic media; however, they show low biocompatibility due to the release of aldehyde compounds. In this study, we report innovative adhesives based on hydrophobically modified Alaska pollock gelatin (hm-ApGltn) with different alkyl or cholesteryl (Chol) groups that adhere to the media of the dissected aorta by combining hm-ApGltns with a biocompatible crosslinker, pentaerythritol poly(ethylene glycol) ether tetrasuccinimidyl glutarate. The modification of alkyl or Chol groups contributed to enhanced adhesion strength between porcine aortic media. The adhesion strength increased with increasing modification ratios of alkyl groups from propanoyl to dodecanoyl groups and then decreased at a modification ratio of ~20 mol %. Porcine aortic media adhered using 7.5Chol-ApGltn adhesive showed stretchability even when expanded and shrunk vertically by 25% at least five times. Hm-ApGltn adhesives subcutaneously injected into the backs of mice showed no severe inflammation and were degraded during the implantation period. These results indicated that hm-ApGltn adhesives have potential applications in type-A aortic dissection.