Repair of the Aortic dissection with surgical glue. P Menu, T Sais, P Corbi, M Rahmati, C Jayle, JM Charrière.

Présentation au sujet: "Repair of the Aortic dissection with surgical glue. P Menu, T Sais, P Corbi, M Rahmati, C Jayle, JM Charrière."— Transcription de la présentation:

1 Repair of the Aortic dissection with surgical glue. P Menu, T Sais, P Corbi, M Rahmati, C Jayle, JM Charrière

2 Since glue was first introduced in 1974 for acute type A aortic dissection, several innovative approaches have been proposed About cerebral protection About extensed cross reparation About distal anastomosis (open or clamped) About proximal reparation (Yacoub-David) The aim of this study were to examine the improvement from these new technics Introduction

3 Material and methods From 1991 to 2001, 58 consecutives patients underwent emergency repair for acute type A aortic dissection 42 men and 16 women Aged from 41 to 85 mean 65.2+-11

4 Hypothermic circulatory arrest and open technics 58 consecutive patients (42 M,16F) mean age 65.2+-11 10 patients +CABG Moderate Hypothemy Clamped technics distal and proximal engluing 48 Patients 39 6 1 2 AA+Yacoub- David 6 2 2

5 Cold Cerebroblegia A new technique of cerebral protection during operation on the transverse aortic arch J Bachet JTCS 1991;102:85-94 The open Technic Circulatory arrest in the main circuit

6 Should the arch be included? When Why ? How ?

7 When ? Intimal tear in the cross Intimal tear not found in the ascending aorta Young patient or Marfan ? Massive False lumen> thrue lumen ? T Kazui, JTCS 2000;119:558--65

8 Why ? Reoperation more frequent (Bachet) « At the emergency procedure, all patients with Marfans disease have a total aortic root replacement » J Bachet JTCS 1994;108: 206 Entre 1977 et 1992, 143 pts ont été opérés pour dissection de type A, 42 pts avec crosse. Sur les 18 Marfan sans extension à la première intervention 7 patients ont été réopérés Sur les 30 opérés avec extension 0 réopération

9 « Lextension de la reconstruction à la crosse réduit le risque de réopération » Le développement de nouvelles techniques de protection encéphalique a considérablement réduit laugmentation du risque opératoire et peut le neutraliser Should the arch be included? E Crawford JTCS 1992-104;46-59

10 How ? Open technic Cold cerbroplegia Retrograde cerebral perfusion during hypothermic circulatory arrest reduces neurologic morbidity M Deeb JTCS 1995;109259-68

11 Réoperation: Poitiers 1991-1999 5 patients 46.2+/-11 (32-54 ) Proximal problem 4 dilatations Distal problem 1

12 Conclusion Our experience suggest that open techniques and fibrin glue for distal anastomosis repair And anatomical reconstruction inspired by M Yacoub without glue for proximal repair improve the early and late outcomes of surgery for type A dissection of the aorta