Treatment of acute type A aortic dissection with intraluminal sutureless prosthesis.

Sutureless intraluminal aortic graft has been used for substitution of aorta, with the advantages of decreasing the aortic cross-clamp time and decreased blood loss. From January 1991 to December 1992, 10 consecutive patients underwent emergency operations to repair acute type A aortic dissection in which sutureless intraluminal grafts were used for replacement of ascending aorta. There were 5 men and 5 women, with ages that ranged from 40 to 74 years (mean, 51 years). The inclusion method was used in all patients. Modified Cabrol shunts were created in 7 patients. Dacron graft (Meadox Medicals, Inc, Oakland, NJ) was used to wrap the ascending aorta in 7 patients. The circulatory arrest time was 33 +/- 13 (mean +/- standard deviation) minutes, and the cardiac ischemic time was 64 +/- 17 minutes. Retrograde superior vena cava cerebral perfusion during circulatory arrest was performed on 4 patients. All patients survived. One patient had a minor stroke and pneumonia with complete recovery. There was no evidence of pseudoaneurysm formation, graft erosion, graft migration, or aortic bleeding in the postoperative period. No patients had permanent renal deficit. Follow-up (1 to 22 months; mean, 9.6 months) of all patients revealed satisfactory graft function, with no device-related deaths and no known complications attributable to the prosthesis, such as thrombosis, erosion, pseudoaneurysm formation, or hemorrhage. Our experience suggests that grafting of the ascending aorta is less hazardous with the sutureless grafts than with the conventional sutured anastomosis technique. We are now using this method whenever possible in all substitutions of the aorta.