Rankin J Scott
Centennial Medical Center and Vanderbilt University, Nashville, TN, USA.
J Heart Valve Dis. 2012 Mar;21(2):263-6.
While running suture anastomoses represent the mainstay of thoracic aortic surgery, advantages may exist for interrupted techniques in selected cases, especially with ascending aortic replacement and concomitant aortic valve repair. Interrupted suture anastomoses precisely reconstruct the sinotubular geometry in dissections, and allow the proximal suture line to be placed close to the coronary arteries and aortic valve posts. With aneurysm extension into the aortic arch, interrupted suture techniques allow hemi-arch replacement without the need for aortic clamp removal and circulatory arrest. By 'sandwiching' all layers of the aortic wall between a Dacron graft on the inside and a Teflon strip on the outside, quite hemostatic anastomoses can be performed, even with poor-quality tissues. Any tearing of the aortic wall adjacent to individual sutures will not loosen the entire suture line, and can be repaired simply by extra suture placement. Thus, in selected situations, interrupted suture methods can be useful for ascending aortic replacement.
虽然连续缝合吻合术是胸主动脉手术的主要方式，但在某些特定情况下，间断缝合技术可能具有优势，尤其是在升主动脉置换术及同期主动脉瓣修复术中。间断缝合吻合术能精确重建夹层中的窦管交界形态，并使近端缝合线靠近冠状动脉和主动脉瓣柱。当动脉瘤扩展至主动脉弓时，间断缝合技术可进行半弓置换，而无需移除主动脉夹和停止循环。通过在主动脉壁各层之间“夹入”内侧的涤纶补片和外侧的特氟龙条带，即使组织质量较差，也能实现相当有效的止血吻合。与单个缝线相邻的主动脉壁撕裂不会使整个缝合线松动，只需额外缝合即可修复。因此，在特定情况下，间断缝合方法对升主动脉置换术可能有用。
