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Replacement of the thoracic aorta with intraluminal sutureless prosthesis
R L Berger1, K J Karlson, R F Dunton
1Overholt Division of Cardiothoracic Surgery, New England Deaconess Hospital, Boston, Massachusetts.
The Annals of Thoracic Surgery
|May 1, 1992
Summary
Sutureless aortic grafting for thoracic aorta replacement showed lower risks and better outcomes compared to traditional sutured methods. Further research is needed to fully understand potential late complications of sutureless prostheses.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Sutureless intraluminal prostheses have been utilized for thoracic aorta replacement.
- Various aortic pathologies necessitate complex surgical interventions.
Purpose of the Study:
- To evaluate the collective experience and outcomes of sutureless intraluminal prosthesis use in thoracic aorta replacement.
- To compare the safety and efficacy of sutureless fixation versus conventional sutured anastomosis techniques.
Main Methods:
- A retrospective survey of 217 operations using sutureless intraluminal prostheses for ascending, arch, and descending thoracic aorta replacement between 1976 and 1990.
- Analysis of underlying disease processes, anastomosis techniques, early and late complications, and operative mortality.
Main Results:
- Sutureless fixation was used in 364 of 434 anastomoses, associated with reduced aortic cross-clamp time and blood loss.
- Operative mortality rates were 13.1% (ascending), 42.9% (arch), and 14.8% (descending).
- Long-term follow-up showed satisfactory graft function, with few early complications and three potential device-related deaths; paraplegia and renal failure incidence was 2.5% for descending aortic grafting.
Conclusions:
- Sutureless grafting of the thoracic aorta appears less hazardous than conventional sutured techniques.
- While early results are promising, potential late complications related to implantation techniques or the prosthesis concept require further investigation.
- Improving surgical techniques may further reduce graft-related complications.