Terumo-Triplex grafts for total arch replacement: analysis of postoperative graft performance

We evaluated the performance of Terumo-Triplex (TRP) with a large-diameter vascular graft sealed with non-biodegradable material in 48 patients who underwent total arch replacement under selective cerebral perfusion between 2004 and 2009. TRP grafts were used in 13 patients (T group), Gelseal graft in 15 (G group), Hemashield graft in 10 (H group) and Intergard graft in 10 (I group). The total tube drainage, time to tube removal, graft dilation ratio and inflammation were evaluated postoperatively. Cardiopulmonary bypass and selective cerebral perfusion times did not differ between groups. Two patients died in hospital. The total drain drainage was significantly lower in the T group (956 ± 156 ml) than in the H (2058 ± 403 ml, p = 0.001) or I (5959 ± 1027 ml, p = 0.01) groups. The time to tube removal was significantly lower in T group and G group than H and I group (T: 3.7 ± 0.4, G: 4.1 ± 0.4, H: 8.3 ± 1.6, I: 18.6 ± 3.6 days, T vs. H, I: p = 0.07, 0.0002, G vs. H, I: p = 0.004, <0.0001). The graft dilation ratio was significantly lower in T group than G group (T: 104 ± 4 vs. 130 ± 7 %, p = 0.001). The max C-reactive protein level was significantly lower in T group (16.2 ± 4.5 mg/dl) than in the G group (19.4 ± 3.2 mg/dl, p = 0.047), H (20.4 ± 4.1 mg/dl, p = 0.048), or I (20.5 ± 4.5 mg/dl, p = 0.013) groups. Maximum body temperature was also lower in the T group (38.2 ± 0.5 °C) than in the G (38.7 ± 0.4 °C, p = 0.011), H (38.9 ± 0.6 °C, p = 0.0087), and I (39.3 ± 0.7 °C, p = 0.0005). Thus, TRP graft might attenuate inflammatory response compared to the other sealed grafts for total arch replacement in patients with aortic arch aneurysm or dissection.