Twelve-year experience with intraluminal sutureless ringed graft replacement of the descending thoracic and thoracoabdominal aorta.

Use of the intraluminal sutureless ringed prosthesis can reduce graft insertion time and avoid difficulties inherent in suturing to friable, diseased aortic tissue. Since 1976 this device has been inserted into the descending thoracic or thoracoabdominal aorta in 42 procedures for aortic dissection and for aneurysmal disease. The operative mortality rate for descending thoracic aortic dissection repair was 14% and that for descending thoracic aortic aneurysm repair was 8%, with an overall mortality rate of 10%. All three of the patients undergoing thoracoabdominal aortic replacement survived. The mean cross-clamp time for sutureless tube graft insertion was 9 minutes. The average blood replacement was 2.4 units/patient. No patient suffered serious neurologic or renal impairment. A single nonfatal case of graft dislodgement occurred after placement. No evidence of hemolysis, pseudoaneurysm formation, graft erosion, graft migration, or anastomotic bleeding was present in any of the remaining patients. Modification of the sutureless intraluminal device to suit the pathologic condition encountered at operation allows rapid repair with a low incidence of anastomotic complication.