"Modified sandwich" technique in the surgery of acute type A aortic dissection

Acute type A aortic dissection is a rapidly progressive and life-threatening condition. Without timely surgical intervention, the mortality rate can reach up to 50% within the first 48 h. Although surgery remains the primary effective treatment, it is associated with significant complexity and potential risks, particularly in managing the aortic root, where both intraoperative and postoperative bleeding complications are common. This study aims to evaluate the efficacy of the modified "sandwich" technique using a synthetic vascular patch for aortic root reconstruction in acute type A aortic dissection surgery.

A retrospective analysis was conducted on the clinical data of 28 patients with acute type A aortic dissection who underwent aortic root reconstruction using the modified "sandwich" technique with synthetic vascular patches at the Department of Cardiovascular Surgery, the Third Hospital of Hebei Medical University, from October 2020 to November 2022. All patients underwent surgical treatment, during which the modified "sandwich" technique was applied for aortic root reconstruction. Statistical analysis was performed on operative time, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, postoperative drainage volume, perioperative mortality, and complications.

All 28 patients underwent successful surgery with a cardiopulmonary bypass (CPB) time of 265.0 (210.0-322.5) min, an aortic cross-clamping (ACC) time of 151.0 (112.0-209.0) min, and a drainage flow rate of 237.5 (126.0-297.0) mL at 12 h postoperatively. There were 2 (7.1%) perioperative deaths caused by renal failure, ischemia in 1 case, and coronary artery causes in 1 case. Postoperative complications included reopening of the chest for hemostasis in 1 case (3.6%) for reasons unrelated to the vascular anastomosis, hemodialysis in 3 cases (10.7%), paraplegia in 1 case (3.6%), and cerebral infarction resulting in impaired mobility of the left upper extremity in 1 case (3.6%). Tracheotomy was performed in 1 case (3.6%), and the duration of mechanical ventilation was 89 (48.0-165) h. Among the 26 recovered patients reviewed with aortic enhancement CT before discharge, the artificial vascular anastomosis had smooth blood flow, though 1 case still had residual entrapment in the sinus of the aorta.

In acute type A aortic dissection surgery, the "modified sandwich" technique using an artificial vascular sheet for aortic root shaping is simple, effective, and easy to master. This method can reduce anastomotic blood seepage and prevent anastomotic tear and bleeding, making it worth recommending for clinical application.