A Modified Branched Graft Inversion Technique Employing a Syringe Inserter in Ascending Aortic Replacement for Type A Aortic Dissection

摘要

Purpose: To achieve good outcomes during aortic surgery with circulatory arrest, a secure and non-bleeding anastomosis must be achieved rapidly to ensure brain protection. We report our initial experiences with a modified Branched Graft Inverting (BGI) technique using an inserter under mild hypothermia. We aimed to reduce the surgical duration and to prevent unnecessary damage to the fragile aorta. Methods: We retrospectively reviewed patients with type A acute aortic dissection (AAD) who underwent distal anastomosis via the modified BGI technique using an inserter between January 2012 and March 2013. Open distal anastomosis was performed under mild hypothermia with right hemisphere perfusion from the right axillary artery. Results: Eight patients were enrolled. There was no mortality. Circulatory arrest time was reproducibly 20.3 ± 1.9 min, which was sufficient to complete non-bleeding distal anastomoses. The average rectal temperature during circulatory arrest was 26.5℃ ± 1.9℃. All patients were extubated the day after the operation without any neurological deficit. Conclusion: The modified BGI technique employing an inserter and mild hypothermia offered easy, secure, and reproducible distal anastomosis for ascending aortic replacement for type A acute aortic dissection. Our outcomes were favorable and support further development of this technique.