Sutureless technique to support anastomosis during thoracic aorta replacement

BACKGROUND: In aortic replacement procedures the aortic wall and Teflon strips form a double layer, with the use of continuous sutures. Surgical glues may or may not be used to enhance the durability of the anastomoses. In this technical report a modification of the aortic stumps preparation is devised. The technique reduces substantially the preparation time of the aortic stumps by the use of ligation clips and a surgical sealant. TECHNIQUE: Suturing is the standard method for the aortic-teflon double-layer formation prior to Dacron anastomosis. In this study, instead of suturing, 5-6 ligation clips are primarily applied on the exterior of the double layer to facilitate proper cooptation. Secondarily, in order to fuse the two layers together, a sealant is injected in between the Teflon and aortic wall. Thus each stump is delivered quickly sutureless for the Dacron anastomosis. Between January 2003 and March 2009 this modified operative technique was performed in 14 cases (group A) with a mean age of 50 ± 16 years. This was contrasted against 24 controls (group B), with a mean age of 40 ± 28 years, treated with the conventional method, where only continuous sutures were used during the anastomosis. All patients were cases of ascending aorta replacement and/or aortic hemi-arch replacement, for acute aortic dissection or aortic dilatation. RESULTS: The pure anastomosis time (stump preparation and Dacron connection) was shortened by approximately 25 minutes depending on surgeon's experience. The anastomosis blood-loss was also significantly reduced in the sutureless group A, as evident by the dry operative field and the limited use of blood products, post-prosthetic graft anastomosis. This reflected to a faster post-operative recovery, faster extubation and fewer complications. At a mean follow-up of 21 ± 7 days, there were no post-operative deaths being related to acute aortic dissection or rupture of the anastomotic site. CONCLUSION: Aortic replacement with the combination of ligation clips and a surgical sealant vs. sutures alone allows easy manipulations of the aorta and adaptation of the diameters, thus optimizing aortic operational timings and hemostasis. Moreover, it prevents blood loss and aortic wall trauma from multiple sutures.