Surgical outcomes of aortic root replacement using the double-felt pledget technique in acute Stanford type A aortic...

Hemostasis at the aortic root during replacement surgery for acute Stanford type A aortic dissection (ATAAD) can be technically challenging due to tissue fragility, often leading to fatal bleeding. We adopted a double-felt pledget technique to improve hemostasis. This study aimed to evaluate the surgical outcomes of this technique. We retrospectively reviewed 231 emergency ATAAD surgeries performed at our hospital between January 2010 and August 2022. Of these, 24 patients underwent aortic root replacement using the double-felt pledget technique. Primary outcomes included postoperative bleeding, need for rethoracotomy, and in-hospital mortality. Long-term survival was assessed using Kaplan-Meier analysis. Among 24 patients (14 men, mean age 60 years), no in-hospital or 30-day mortality occurred. No patients required reoperation for bleeding. The average hospital stay was 28 days. During a mean follow-up of 3.7 years, only 1 patient died of an unknown cause, and 3 required further aortic interventions. The technique was particularly effective in reoperative cases and those with connective tissue disorders. The double-felt pledget technique achieved favorable hemostasis and surgical outcomes in aortic root replacement for ATAAD. This technique may contribute to improving operative safety in high-risk aortic root procedures.