Midterm results of vascular ring connector in open surgery for aortic dissection

Objectives This study observed midterm results of vascular ring connectors in surgery for aortic dissection. Methods Vascular ring connectors were used as stents in vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure ringed vascular grafts from outside the aorta. Resu...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2012, Vol.143 (1), p.72-77.e3
Main Authors: Wei, Jeng, MD, MSD, Chang, Chung-Yi, MD, Chuang, Yi-Cheng, MD, Sue, Sung-How, MD, Lee, Kuo-Chen, MD, Wu, Ching-Wen, MD, Chang, Cheng-Hsi, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Aorta, Thoracic
Aortic Diseases - surgery
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - methods
Cardiology. Vascular system
Cardiothoracic Surgery
Diseases of the aorta
Female
Humans
Male
Medical sciences
Middle Aged
Pneumology
Stents
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Objectives This study observed midterm results of vascular ring connectors in surgery for aortic dissection. Methods Vascular ring connectors were used as stents in vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure ringed vascular grafts from outside the aorta. Results From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with vascular grafts and vascular ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%. Conclusions Use of vascular ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2011.09.013