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

In surgery for acute type A aortic dissection, controlling bleeding from the posterior wall of the proximal anastomosis is particularly challenging. To address this, we use the "reversed turn-up technique." For the reinforcement of the proximal aortic stump, Teflon felt strips were placed inside and outside the suture line with 4-0 polypropylene continuous transverse mattress sutures, and BioGlue was applied to the false lumen. For the posterior wall, circumferential interrupted sutures using 3-0 polypropylene with pledgets were placed, passing the needle from the inside to the outside of the aorta and from the outside to the inside of the graft, resulting in an "inward" turn-up of the posterior wall. Continuous sutures were added for further reinforcement. For the anterior wall, circumferential interrupted sutures using 3-0 polypropylene with pledgets were placed, passing the needle from the outside to the inside of the aorta and from the inside to the outside of the graft, achieving an outward turn-up. This technique provides reliable hemostasis, particularly for the posterior wall. From August 2016 to January 2024, we performed initial and isolated ascending aortic replacement for acute type A aortic dissection in 73 patients using the reversed turn-up technique. The postoperative 30-day mortality rate was 4.1%, and no patients required re-exploration for bleeding.