Acute type A dissection of the aorta: surgical management with the sutureless intraluminal prosthesis

The sutureless intraluminal prosthesis was used in 22 patients with acute dissection of the ascending aorta (type A) between May, 1982, and September, 1985. The patients ranged from 26 to 77 years old (mean, 58 years). Diagnosis was established by aortogram in 18 patients and by two-dimensional echocardiogram in 4 patients. Additional procedures included resuspension of the aortic valve in 7 patients, single coronary artery bypass in 1 patient, and cesarean delivery of a term pregnancy in 1 patient. Nineteen patients survived operation and were discharged from the hospital (86% early survival). Three patients died, 2 of hemorrhage and myocardial failure in the operating room, and 1 of sepsis following a prolonged hospitalization. Early postoperative complications included one instance of renal failure, one perioperative myocardial infarction, and one cerebrovascular accident (CVA). There were no reoperations for bleeding. Follow-up was obtained on 17 patients (90%) and ranged from 10 to 50 months (mean, 30 months). Thirteen of the survivors are well, 11 have returned to work, 2 have had a CVA, and 1 has a descending thoracic aneurysm. We conclude that the intraluminal graft is a good option for repair of acute type A dissections because it reestablishes central aortic flow, obliterates the false channel entry site, minimizes operative blood loss, and permits expeditious repair with minimal trauma to friable tissues.