A Novel Selective Sinus Reinforcement Technique for Acute Type A Aortic Dissection Involving the Aortic Root

Fig. 1.. Steps of the selective sinus reinforcement (SSR) technique for dissection involving a coronary sinus and the non-coronary sinus (NCS). (A) A rectangular Dacron patch is prepared and placed externally around the aortic root. A triangular opening was cut longitudinally at the level corresponding to the coronary arteries. (B) A single patch consisting of two interconnected U‑shaped sections is fashioned to match the dimensions of the involved coronary sinus and NCS. (C) The U‑shaped patch is inserted inside the affected sinuses as an internal liner, while the rectangular Dacron patch is positioned externally, creating a “sandwich” reinforcement around the native sinus wall. (D) The patches are secured to the aortic annulus using a running 5‑0 polypropylene suture, beginning at the sinus nadir and continuing toward the commissures. (E) A 3–4 mm circular opening is created in the coronary sinus portion of the internal patch using fine‑tip electrocautery. The coronary ostium and adjacent sinus wall are anastomosed to the margins of both internal and external patch openings with a running 6‑0 polypropylene suture. (F) The completed reconstruction shows the restored root with inner and…

Fig. 2.. Steps of the selective sinus reinforcement (SSR) technique for dissection involving all three sinuses. (A) A rectangular Dacron patch is prepared and positioned externally around the aortic root. Triangular openings are created along the patch corresponding to the left and right coronary artery positions. (B) A single patch composed of three interconnected U‑shaped sections is fashioned to match the size and contour of each sinus. (C) The tripartite U‑shaped patch is deployed inside the sinuses as an internal liner, while the rectangular patch is wrapped externally around the root, forming a three‑layer reconstruction. (D) Coronary ostial reconstruction is performed using the technique previously described, with circular openings created in the internal patch and anastomosed to the coronary ostia using a running 6‑0 polypropylene suture.

Fig. 3.. Steps of the selective sinus reinforcement (SSR) technique for dissection localized to the non-coronary sinus (NCS). (A) A segment of cylindrical Dacron graft (~5 cm in length) is opened longitudinally to form a rectangular patch for external reinforcement. (B) A separate U‑shaped patch is trimmed to match the anatomical dimensions of the non-coronary sinus. (C) The U‑shaped patch is positioned inside the NCS as an internal support, while the rectangular patch is secured externally over the same sinus. (D) The sinus is reconstructed using the previously described suturing technique, with no need for coronary reimplantation in this setting.

Fig. 4.. Overall survival after the selective sinus reinforcement for valve-sparing aortic root repair in acute type A dissection. Dotted lines indicate 95% confidence intervals, with numbers at the bottom of the figure showing numbers at risk for the given time points.

Fig. 5.. Echocardiographic evidence of aortic insufficiency (AI) in each patient at the time points.

Fig. 6.. The diameters of aortic root at each follow-up time point. SOV, sinuses of Valsalva.