Operative technique: sutureless type II hybrid arch repair for acute type A aortic dissection

Hybrid arch repair improved surgical outcomes in aneurysmal disease. Sutureless anastomosis using an intraluminal ringed graft and stent graft bridging has been reported. We incorporate the vascular ring connector, angiography-assisted sutureless telescoping anastomosis technique, and thoracic endovascular aortic repair, rendering the hybrid arch repair for acute type A aortic dissection sutureless. Herein, we presented our sutureless procedure for acute type A aortic dissection.

Between January 2022 and April 2023, 19 patients who underwent sutureless type II hybrid arch repair were enrolled. The surgical procedures were described. The preoperative demographics, operative details, postoperative outcomes and follow-up results were retrospectively collected.

Nineteen patients with a median age of 62 (interquartile range [IQR]: 10.5) and male dominant in 73.7% were recorded. The sutureless type II hybrid arch repair was performed in a median operative time of 397 min (IQR: 111.5), with a cardiopulmonary bypass time of 184 min (IQR: 52.5). The fully sutureless type II hybrid arch repair further reduced the abovementioned times. In-hospital death was two in 10.5%. Seventeen discharged patients had regular follow-ups in a median of 553 days (IQR: 129). The serial computed tomography scan revealed all reconstructed arch vessels were patent, and positive aortic remodelling was observed at the arch and thoracic endoprosthesis levels at 100% and 94.2%, respectively.

Sutureless type II hybrid arch repair is feasible, demonstrating complete procedural success and favourable postoperative outcomes in mid-term follow-up. Long-term monitoring is necessary to assess this procedure's durability and potential complications.