Özçetin Akkuş Ayşe, Çeliksöz Muzaffer
Ankara Training and Research Hospital, Ankara, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Dec 31;32(4 Suppl 2):036-36. doi: 10.5606/tgkdc.dergisi.2024.msb-17. eCollection 2024 Nov.
This study aimed to define a novel technique to ensure the safety of distal anastomosis in acute type A aortic dissection, a condition with many possible complications.
The "DR MÇ" technique consisted of two components: reinforcing the wall of the dissected aorta and aorta-graft diameter matching. The first technique was applied in our clinic, but the second method had not yet been tested. First, a Teflon band was sutured around the outer wall of the aorta, leaving 5 mm of the aorta at the open end to later contribute to hemostasis during anastomosis. Afterward, the graft was sutured to the aorta; however, the sutures were closer to the anastomosis than to the fixing sutures of the Teflon band. This prevented the tearing of the aorta by distributing the axial forces on the aorta and the anastomosis. The adjustment of graft diameter for the aorta was done accordingly; the graft was cut in an oblique pattern, and an extra elliptical piece was sutured to one side of the graft. This method ensured durability (narrowing of the dissected aorta could cause tearing), and the remaining parts of the graft at the outer side of the anastomosis provided extra hemostatic support.
Mortality was often caused by bleeding from the suture points covered by the Teflon. In our center, this method was applied in an attempt to provide better results; however, the sample size was insufficient to provide statistically significant results.
In acute type A aortic dissection, the endurance of aortic tissues is impaired, and therefore, conventional anastomosis may not be enough for hemostasis. This technique is a safer approach for aortic tissue endurance.
本研究旨在定义一种新技术，以确保急性A型主动脉夹层（一种有许多可能并发症的疾病）远端吻合口的安全性。
“DR MÇ”技术由两个部分组成：加固夹层主动脉壁和主动脉-移植物直径匹配。第一种技术已在我们的临床中应用，但第二种方法尚未经过测试。首先，将一条特氟龙带缝合在主动脉外壁周围，在开口端留出5毫米的主动脉，以便在吻合过程中有助于止血。之后，将移植物缝合到主动脉上；然而，缝线更靠近吻合口而不是特氟龙带的固定缝线。这通过将轴向力分布在主动脉和吻合口上来防止主动脉撕裂。相应地对移植物直径进行调整以适应主动脉；将移植物切成斜形，并将一块额外的椭圆形片缝合到移植物的一侧。这种方法确保了耐用性（夹层主动脉变窄可能导致撕裂），并且吻合口外侧的移植物其余部分提供了额外的止血支持。
死亡往往是由特氟龙覆盖的缝合点出血引起的。在我们中心，应用此方法试图获得更好的结果；然而，样本量不足，无法得出具有统计学意义的结果。
在急性A型主动脉夹层中，主动脉组织的耐力受损，因此，传统的吻合术可能不足以实现止血。这种技术对于主动脉组织耐力来说是一种更安全的方法。
