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 arrestand open technics

58 consecutive patients (42 M,16F) mean age 65.2+-11

10 patients

+CABG

Moderate HypothemyClamped technics

distal and proximal engluing

48 Patients

39

61

2 AA+Yacoub-David

6

2

2

Cold CerebroblegiaA new technique of cerebral protection during operation on the transverse aortic

archJ Bachet JTCS 1991;102:85-94

The open Technic

Circulatory arrest inthe main circuit

Should the arch be included?WhenWhy ?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 réopérésSur 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 protectionencéphalique a considérablement réduit l’augmentationdu risque opératoire et peut le neutraliser

Should the arch be included? E Crawford JTCS 1992-104;46-59

How ? Open technic

Cold cerbroplegiaRetrograde 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