Comparative Analysis Of Different Proximal Anastomosis For Acute Type A Aortic Dissection

Objective:To compare and analyze the postoperative complications and one-year follow-up results of two different surgical methods of eversion technique(adventitial eversion and prosthesis eversion technique)and sandwich technique(double patch sandwich technique)in proximal anastomosis of acute type A aortic dissection(ATAAD).The safety and effectiveness of the adventitial eversion and prosthesis eversion technique in the proximal anastomosis of aortic dissections are evaluated,and it is expected to provide a new idea and development direction for the proximal anastomosis of acute type A aortic dissection roots.Methods:Between December 2015 and November 2019,435 patients with ATAAD underwent surgical repair in Qilu Hospital of Shandong University,143 patients were included in this study according to the inclusion and exclusion criteria,109 were males and 34 were females,with an average age of 50.6±10.3years and an average weight of 77.4±13.7kg.Patients were divided into two groups according to the difference of proximal anastomosis,the eversion technique group(adventitial eversion and prosthesis eversion technique,n=64)and the sandwich technique group(double patch sandwich technique,n=79).Collect the patient’s preoperative,intraoperative,postoperative and follow-up data.Preoperative data include age,gender,weight,smoking and drinking history,past medical history(including hypertension,cerebral infarction,chronic kidney disease,diabetes),results of the first auxiliary examination after admission(albumin,blood lipids,liver function,creatinine,Cystatin C,D-dimer,LVEF).Intraoperative data include operation time,cardiopulmonary bypass(CPB)time,aortic cross-clamp(ACC)time,proximal anastomosis(PA)time,circulatory arrest(CA)time,circulatory arrest temperature,fresh frozen plasma(FFP)transfusion and leukocyte poor red blood cells(LPRBC)transfusion.Postoperative data include the 1st day drainage,reoperation for bleeding,mechanical ventilation time,length of hospital stay,postoperative complications(including paraplegia,stroke,gastrointestinal bleeding,renal failure),tracheotomy.The one-year outcome of the patients after operation,including death,reoperation,and aortic root events were followed upResults:The mean operation time was 466±73 minutes in the eversion technique group and 513±81 minutes in the sandwich technique group(P<0.001).Compared with the sandwich technique group,patients in the eversion technique group also showed a shorter time on proximal anastomosis(38±12 minutes vs.58±20 minutes,P<0.001),cardiopulmonary bypass(195±26 minutes vs.211±40 minutes,P=0.003),and aortic cross-clamp(120±23 minutes vs.134±27 minutes,P=0.002).No statistical differences were observed in the postoperative morbidities and one-year follow-up outcomes,including mortality and the incidences of aortic root reoperation and aortic root events.Conclusions:Proximal anastomosis using adventitial eversion and prosthesis eversion technique is a safe and effective surgical option for ATAAD patients,with favorable perioperative and one-year follow-up results.