Intimal-protected adventitial inversion technique accelerates the obliteration of a patent false lumen

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Aortic Dissection Repair

Background:

• Optimal reconstruction of the dissected aortic stump in acute type A dissection is debated.
• The intimal-protected adventitial inversion technique (iPAIT) was developed to safeguard fragile intimal tissue during graft insertion.

Purpose of the Study:

• To assess the safety and efficacy of the intimal-protected adventitial inversion technique (iPAIT) for acute type A dissection.
• To compare iPAIT outcomes against a historical control using gelatin-resorcinol-formaldehyde (GRF) glue.

Main Methods:

• A retrospective review of 146 patients with acute type A dissections undergoing thoracic aortic surgery.
• Comparison of 69 patients treated with iPAIT for distal aortic anastomosis versus 25 patients treated with GRF glue.
• Extended total aortic arch replacement was performed in 119 patients (81.5%).

Main Results:

• Hospital mortality was lower in the iPAIT group (2.9%) compared to the GRF group (8.0%).
• Postoperative computed tomography revealed a significantly higher false lumen obliteration rate in the iPAIT group (90.9%) versus the GRF group (65.2%).
• The 8-year aortic event-free survival rate was significantly higher for iPAIT (81.3%) than for GRF (47.4%).

Conclusions:

• The intimal-protected adventitial inversion technique (iPAIT) is associated with low mortality for acute type A dissections.
• iPAIT demonstrates promising midterm survival, potentially accelerating false lumen obliteration and preventing late aortic events.