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

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

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

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

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

Should the arch be included? When Why ? How ?

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:

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

« 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 ;46-59

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

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

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