Hemostatic Proximal Anastomosis for Type A Acute Aortic Dissection: Reversed Turn-Up Technique (Akita Method)

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Repair

Background:

• Controlling posterior wall bleeding at the proximal anastomosis in acute type A aortic dissection surgery is a significant challenge.
• The development of effective hemostatic techniques is crucial for improving patient outcomes.

Purpose of the Study:

• To describe and evaluate the efficacy of the "reversed turn-up technique" for managing bleeding in the proximal anastomosis during acute type A aortic dissection repair.
• To assess the safety and effectiveness of this technique in a clinical setting.

Main Methods:

• The reversed turn-up technique involves reinforcing the proximal aortic stump with Teflon felt strips and BioGlue.
• Specific suturing methods create an "inward" turn-up for the posterior wall and an "outward" turn-up for the anterior wall.
• The technique was applied in 73 patients undergoing initial and isolated ascending aortic replacement for acute type A aortic dissection.

Main Results:

• The reversed turn-up technique demonstrated reliable hemostasis, particularly for the challenging posterior wall.
• The postoperative 30-day mortality rate was 4.1% in the studied patient cohort.
• No patients required re-exploration for bleeding, indicating the technique's effectiveness in preventing this complication.

Conclusions:

• The reversed turn-up technique is a safe and effective method for achieving hemostasis in the proximal anastomosis during acute type A aortic dissection surgery.
• This technique offers a reliable solution for managing bleeding, potentially improving surgical outcomes and reducing complications.