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Have Hemiarch Replacements and Adhesives Improved Outcomes in Acute Type A Dissection?

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Book cover Controversies in Aortic Dissection and Aneurysmal Disease

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Abstract

Surgical treatment strategies for acute type A aortic dissection continue to evolve. Proximal reconstruction typically involves aortic valve resuspension with preservation of the aortic root, unless the tear site extends into the aortic root. Although there is strong consensus on proximal aortic reconstruction strategy, open distal aortic reconstruction as a transverse hemiarch replacement under circulatory arrest is still not adopted by many groups, even though evidence supports for this distal reconstructive strategy. In addition to proximal and distal aortic stabilization, one of the essential aspects of repair remains reapposition of the dissection flap in the aortic root and the ascending aorta. To this effect, there is literature supporting for many techniques, including placement of adhesives into the dissection flap and/or placement of felt material in the dissection flap to reappose the intima, media and the adventia of the dissected aorta. But overall, there is no clear consensus on the ideal technique for apposition of the dissection flap.

In this chapter, we review various distal reconstructive strategies for type A aortic dissection, with a focus on the role for transverse hemiarch open distal aortic reconstruction. We also review the current literature on the use of adhesives such as glue products for aortic reconstruction. Finally, we discuss our institutional bias for proximal and distal aortic reconstruction of type A aortic dissection, and our typical practice in the use of felt material/adhesives for treating the proximal aortic root and distal aortic arch dissection flap.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Prashanth Vallabhajosyula MD, MS, Caroline Komlo BS & Joseph E. Bavaria MD

  2. Department of Surgery, Mercy Catholic Medical Center, 1500 Lansdowne Ave., Darby, PA, 19023, USA

    Tyler Wallen DO

  3. Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA

    Wilson Y. Szeto MD

Authors
  1. Prashanth Vallabhajosyula MD, MS
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  2. Caroline Komlo BS
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  3. Tyler Wallen DO
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  4. Wilson Y. Szeto MD
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  5. Joseph E. Bavaria MD
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Corresponding author

Correspondence to Joseph E. Bavaria MD .

Editor information

Editors and Affiliations

  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Vallabhajosyula, P., Komlo, C., Wallen, T., Szeto, W.Y., Bavaria, J.E. (2014). Have Hemiarch Replacements and Adhesives Improved Outcomes in Acute Type A Dissection?. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_12

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  • DOI: https://doi.org/10.1007/978-1-4471-5622-2_12

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5621-5

  • Online ISBN: 978-1-4471-5622-2

  • eBook Packages: MedicineMedicine (R0)

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