Aortic false lumen patency following the adventitial inversion technique for acute DeBakey type I aortic dissection

We determined the beneficial effect of the adventitial inversion technique on reducing the patency rate of false lumens in acute aortic dissection (AAD) compared with the sandwich technique using Teflon felts.

Between 2003 and 2008, 65 consecutive patients with DeBakey type I AAD underwent emergent surgery. To obliterate a false lumen, the sandwich technique was used in 35 patients (group TS) before October 2006 and the adventitial inversion technique was used in 30 patients (group AIT) subsequent to October 2006. The false lumen patency was evaluated with computerized tomo-angiography (CTA).

There were three operative deaths (AIT [n = 1]; TS [n = 2]). The operative morbidity rate was not different (AIT = 17.2%, TS = 21.2%). Follow-up was completed in 56 patients (90.3%) with a mean duration of 12.2 ± 4.9 months in the group AIT and 31.8 ± 19.8 months in the group TS. During the follow-up period, there were no deaths or aortic events. In 53 patients (AIT [n = 26]; TS [n = 27]), a postoperative one-year CTA was obtained and compared with that of immediate postoperative one. The patency rate in the immediate postoperative period was 30.8% in group AIT and 63.0% in group TS (p = 0.019). On the follow-up CTA, it was 15.4% in group AIT and 48.1% in group TS (p = 0.018), respectively.

The adventitial inversion technique can be performed safely and obliterate the false lumen more effectively than the sandwich technique. The adventitial inversion technique might decrease the incidence of reoperations related to aneurysmal changes and improve survival or event-free survival.