An interrupted suture technique for ascending aortic replacement concomitant to aortic valve repair

While running suture anastomoses represent the mainstay of thoracic aortic surgery, advantages may exist for interrupted techniques in selected cases, especially with ascending aortic replacement and concomitant aortic valve repair. Interrupted suture anastomoses precisely reconstruct the sinotubular geometry in dissections, and allow the proximal suture line to be placed close to the coronary arteries and aortic valve posts. With aneurysm extension into the aortic arch, interrupted suture techniques allow hemi-arch replacement without the need for aortic clamp removal and circulatory arrest. By 'sandwiching' all layers of the aortic wall between a Dacron graft on the inside and a Teflon strip on the outside, quite hemostatic anastomoses can be performed, even with poor-quality tissues. Any tearing of the aortic wall adjacent to individual sutures will not loosen the entire suture line, and can be repaired simply by extra suture placement. Thus, in selected situations, interrupted suture methods can be useful for ascending aortic replacement.