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Repair of the Aortic dissection with surgical glue.

Repair of the Aortic dissection with surgical glue. P Menu, T Sais, P Corbi, M Rahmati, C Jayle , JM Charrière. Introduction. Since glue was first introduced in 1974 for acute type A aortic dissection, several innovative approaches have been proposed About cerebral protection

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Repair of the Aortic dissection with surgical glue.

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  1. Repair of the Aortic dissection with surgical glue. P Menu, T Sais, P Corbi, M Rahmati, C Jayle , JM Charrière

  2. Introduction • Since glue was first introduced in 1974 for acute type A aortic dissection, several innovative approaches have been proposed • About cerebral protection • About extensed cross reparation • About distal anastomosis (open or clamped) • About proximal reparation (Yacoub-David) The aim of this study were to examine the improvement from these new technics

  3. Material and methods • From 1991 to 2001, 58 consecutives patients underwent emergency repair for acute type A aortic dissection • 42 men and 16 women • Aged from 41 to 85 mean 65.2+-11

  4. 58 consecutive patients (42 M,16F) mean age 65.2+-11 10 patients 48 Patients Hypothermic circulatory arrest and open technics Moderate Hypothemy Clamped technics distal and proximal engluing 6 2 39 6 1 2 2 AA+Yacoub- David +CABG

  5. The open Technic Cold CerebroblegiaA new technique of cerebral protection during operation on the transverse aortic archJ Bachet JTCS 1991;102:85-94 Circulatory arrest in the main circuit

  6. Should the arch be included?WhenWhy ?How ?

  7. When ? • Intimal tear in the cross • Intimal tear not found in the ascending aorta • Young patient or Marfan ? • Massive False lumen> thrue lumen ? T Kazui, JTCS 2000;119:558--65

  8. Why ? Entre 1977 et 1992, 143 pts ont été opérés pour dissection de type A , 42 pts avec crosse. Sur les 18 Marfan sans extension à la première intervention 7 patients ont été réopérés Sur les 30 opérés avec extension 0 réopération • Reoperation more frequent (Bachet) • « At the emergency procedure, all patients with Marfan’s disease have a total aortic root replacement » • J Bachet JTCS 1994;108: 206

  9. Should the arch be included? E Crawford JTCS 1992-104;46-59 • « L’extension de la reconstruction à la crosse réduit le risque de réopération » Le développement de nouvelles techniques de protection encéphalique a considérablement réduit l’augmentation du risque opératoire et peut le neutraliser

  10. How ? Open technic Cold cerbroplegia Retrograde cerebral perfusion during hypothermic circulatory arrest reduces neurologic morbidity M Deeb JTCS 1995;109259-68

  11. Réoperation: Poitiers 1991-1999 • 5 patients 46.2+/-11 (32-54) Distal problem 1 Proximal problem 4 dilatations

  12. Conclusion • Our experience suggest that open techniques and fibrin glue for distal anastomosis repair • And anatomical reconstruction inspired by M Yacoub without glue for proximal repair improve the early and late outcomes of surgery for type A dissection of the aorta

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