eComment: Fibrin glue reinforced Teflon felt sandwich for the prevention of anastomotic leak in replacement of ascending aorta for acute aortic dissection

We read with great interest the article by Tanaka et al. [1] in which they stressed on a vital issue of aortic dissection surgery, ‘the anastomotic leak’ leading to functional false lumen. We wanted to contribute to the paper with the technique that we performed in some of our patients undergoing ascending aortic replacement for aortic dissection. Indeed, patency of the false lumen is one of the main predictors of mortality and morbidity in the mid-long run in patients surviving aortic dissection. Literature includes many reports of different techniques from different authors which can be applied to completely obliterate the false lumen; hence, direct the blood flow into the true lumen [1–4]. However, despite tremendous efforts and sophisticated methods, leak from the suture lines still account for an important problem. In our surgical practice, to prevent suture line leak, we sometimes prefer fibrin glue reinforced Teflon felt sandwich. In this method, three separate encircling Teflon felts are placed consecutively to the outer surface, between the intima and media layers and inner surface of the aorta. Fibrin glue is applied on and under the felt placed between the intima and media layers. Later, the reconstruction is sewn continuously with a 4.0 polypropylene suture. Following replacement of the aorta with a tube graft, again fibrin glue is applied over the suture lines. Although long-term data regarding the method are not available, up to this date follow-up data seem promising in the prevention of anastomotic leak and patent false lumen. We would like to congratulate the authors for their article and conclusion pointing out the importance of the anastomotic leak in ascending aortic replacement for acute aortic dissection in their series of 100 patients with long-term follow-up.