JTCVS open · 2025
Twenty-year experience of supracoronary reconstruction with fibrin glue in type A acute aortic dissection.
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Uchida Keiji, Yasuda Shota, Cho Tomoki, Minami Tomoyuki, Kasama Keiichiro, Kobayashi Yoshiyuki, Kaneko Shotaro, Ohnakatomi Yasuko, Saito Aya
Аннотация
OBJECTIVE: In surgery for type A acute aortic dissection, we perform supracoronary reconstruction with fibrin glue when the sinus of Valsalva has no intimal tears, and the diameter is ≤ 45 mm. This study aimed to clarify the surgical outcomes with fibrin glue, the incidence of aortic root events, and the influence of the preoperative severity of aortic regurgitation (AR) on aortic root events.
METHODS: Among 621 patients who underwent central repair in the past 20 years, we included 546 who underwent supracoronary reconstruction (87.9%). We closed the false lumen using fibrin glue and placed inner and outer polytetrafluoroethylene felt strips. The mild AR group included patients with no, trivial, or mild preoperative AR, whereas the severe AR group included patients with moderate or severe AR.
RESULTS: Acute aortic root events occurred in 19 patients (3.5%), and the incidence was higher in the severe AR group than in the mild AR group (9 [5.9%] vs 8 [2.2%]; P = .029). The long-term outcomes were investigated in 486 patients who underwent supracoronary reconstruction and were subsequently discharged. Late events occurred in 13 patients (2.7%), the 5-year and 10-year event-free rates were 98.4% and 95.1%, respectively. The pseudoaneurysm-free rate was 99.8% at 10 years. The 5-year and 10-year event-free rates were lower in the severe AR group than in the mild AR group (97.1% vs 99.3% and 85.8% vs 98.5%, respectively; P = .001).
CONCLUSIONS: Supracoronary reconstruction can be performed safely with fibrin glue with excellent long-term outcomes. Preoperative AR is a risk factor for aortic root events.
METHODS: Among 621 patients who underwent central repair in the past 20 years, we included 546 who underwent supracoronary reconstruction (87.9%). We closed the false lumen using fibrin glue and placed inner and outer polytetrafluoroethylene felt strips. The mild AR group included patients with no, trivial, or mild preoperative AR, whereas the severe AR group included patients with moderate or severe AR.
RESULTS: Acute aortic root events occurred in 19 patients (3.5%), and the incidence was higher in the severe AR group than in the mild AR group (9 [5.9%] vs 8 [2.2%]; P = .029). The long-term outcomes were investigated in 486 patients who underwent supracoronary reconstruction and were subsequently discharged. Late events occurred in 13 patients (2.7%), the 5-year and 10-year event-free rates were 98.4% and 95.1%, respectively. The pseudoaneurysm-free rate was 99.8% at 10 years. The 5-year and 10-year event-free rates were lower in the severe AR group than in the mild AR group (97.1% vs 99.3% and 85.8% vs 98.5%, respectively; P = .001).
CONCLUSIONS: Supracoronary reconstruction can be performed safely with fibrin glue with excellent long-term outcomes. Preoperative AR is a risk factor for aortic root events.