Key result
Extended adventitial inversion and graft eversion reduces early reoperation events vs aorta wrapping and shunting.
Why the study?
Surgical approaches for mildly affected aortic sinus in aortic dissection are varied and controversial, necessitating comparison of new reconstruction techniques.
Does the extended adventitial inversion suture and graft eversion anastomosis technique reduce reoperation-related and fatal events compared to aorta wrapping and right atrial shunt technique in patients with mildly affected aortic sinus undergoing root treatment of aortic dissection?
RCT (n=92)
Open-label
Random number method
No
Does the extended adventitial inversion suture and graft eversion anastomosis technique reduce reoperation-related and fatal events compared to aorta wrapping and right atrial shunt technique in patients with mildly affected aortic sinus undergoing root treatment of aortic dissection?
p-value: p=<0.01
The extended adventitial inversion suture and graft eversion anastomosis technique is a safe and effective surgical strategy that shortens operation time and prevents near-term dilation of the sinotubular junction in patients with mildly affected aortic sinus.
May inform technique selection in aortic dissection repair; extends observational comparisons but leaves open need for randomized confirmation.
Background The surgical approaches for a mildly affected aortic sinus (AS) are varied and controversial. Here, the AS was reconstructed using the extended adventitial inversion with graft eversion anastomosis technique before its perioperative and short-term efficacy was compared with that of the vascular grafts that wrap the aortic wall and the right atrial shunt technique, providing a new basis for surgical management strategies. Method A total of 101 patients with mildly affected AS were enrolled in the clinical trial. The extended adventitial inversion suture and the graft eversion anastomosis technique was performed in group A. Aorta wrapping and the right atrial shunt technique were performed in group B. The primary endpoints were reoperation-related events and fatal events related to the aorta, while the secondary endpoints were the duration of surgery and structural changes in the aortic root. Cardiac ultrasound and aortic computed tomography angiography examinations were performed before surgery, 2 weeks after surgery, and 1 year after surgery. Results Compared to group B (n = 56), group A (n = 36) had a significantly shorter duration of surgery (the time from skin incision to skin closure) and a reduced time from shutdown to skin closure (P < 0.05). Cardiovascular ultrasound examinations performed at follow-up 12 months after surgery and 2 weeks after surgery revealed a significant increase in the diameter of the aortic sinotubular junction (STJ) of group B (n = 50) (P < 0.05). The extended adventitial inversion suture and the graft eversion anastomosis technique (n = 33) performed better than Aorta wrapping and the right atrial shunt technique in terms of persistence of the false lumen closure effect, anastomotic leakage, and reduction in aortic valve (P < 0.05), and there was a significant difference between the two groups in terms of the incidence of events related to reoperation (P < 0.05). Conclusion Compared with the aorta wrapping and the right atrial shunt technique, the extended adventitial inversion suture and the graft eversion anastomosis technique allow shortening of the operation time and preventing near-term dilation of the STJ, with improved safety and an improved short-term surgical effect.
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Gao et al. (2022) conducted an RCT in Acute A-type aortic dissection with mildly affected aortic sinus (n=92). Extended adventitial inversion suture and graft eversion anastomosis technique vs. Aorta wrapping and right atrial shunt technique was evaluated on Incidence of early postoperative reoperation-related events (p=<0.01). The extended adventitial inversion suture and graft eversion anastomosis technique significantly reduced the incidence of early postoperative reoperation-related events compared to the aorta wrapping and right atrial shunt technique (P < 0.01).
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