Repair of the Aortic dissection with surgical glue'

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Repair of the Aortic dissection with surgical
glue.

• P Menu, T Sais, P Corbi, M Rahmati, C Jayle , JM
  Charrière

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Introduction

• 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
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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

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58 consecutive patients (42 M,16F) mean age
65.2-11
10 patients
48 Patients
Hypothermic circulatory arrest and open technics
Moderate Hypothemy Clamped technics distal and
proximal engluing
6
2
39
6
1
2
2
AAYacoub- David
CABG
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Cold CerebroblegiaA new technique of cerebral
protection during operation on the transverse
aortic archJ Bachet JTCS 199110285-94
The open Technic
Circulatory arrest in the main circuit
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Should the arch be included?WhenWhy ?How ?
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When ?

• Intimal tear in the cross
• Intimal tear not found in the ascending aorta
• Young patient or Marfan ?
• Massive False lumengt thrue lumen ?

T Kazui, JTCS 2000119558--65
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Why ?
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 réopérés Sur les
30 opérés avec extension 0 réopération

• Reoperation more frequent (Bachet)
•  At the emergency procedure, all patients with
  Marfans disease have a total aortic root
  replacement 
• J Bachet JTCS 1994108 206

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Should the arch be included? E Crawford JTCS
1992-10446-59

•  Lextension de la reconstruction à la crosse
  réduit le risque de réopération 

Le développement de nouvelles techniques de
protection encéphalique a considérablement réduit
laugmentation du risque opératoire et peut le
neutraliser
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How ?
Open technic
Cold cerbroplegia
Retrograde cerebral perfusion during hypothermic
circulatory arrest reduces neurologic morbidity
M Deeb JTCS 1995109259-68
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Réoperation Poitiers 1991-1999

• 5 patients 46.2/-11 (32-54)

Distal problem 1
Proximal problem 4 dilatations
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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