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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
AFRICA
15
graft was approximated to the aorta using four mattress sutures.
Use of Surgicel to prevent bleeding at the suture line during
surgery may lead to a pressure effect on the coronary artery,
while tissue adhesives may compress coronary ostia from the
outer surface and lead to ischaemia, embolism, necrosis of
the aortic tissue and prosthetic valve dysfunction.
3,12
Wrapping
with bovine pericardium has also been proposed for bleeding
control at the suture lines.
12
Graft infection in the ‘dead space’
has been reported, even with wrapping using autogenous aortic
tissue in ascending aortic grafting.
13
The infection risk due to the
formation of a potential dead space between the two grafts, as
well as the degree of inflammation caused by the wrapping of
a synthetic graft using a second biological graft are currently
unknown.
When there is no adequate space for cross-clamping in
ascending aortic lesions, antegrade perfusion with axillary
artery cannulation may be reliably used.
14
In order to achieve
better exposure of the distal anastomosis and to perform aortic
tissue eversion, we prefer an open anastomosis technique for
the distal anastomosis, using selective cerebral perfusion via the
axillary artery in all cases. Using this approach, there were no
postoperative complications.
This study has the obvious limitations of retrospective
studies. All data were obtained from medical records. Since
we routinely perform reinforcement of suture lines with aortic
eversion in ascending aortic surgery, there was no control group.
Prospective, randomised studies are needed to improve our
results.
Conclusion
In ascending aortic surgery, the thin, fragile aorta is subjected
to eversion to obtain a double-layered tissue. In this technique
using viable aortic tissue, the risk of bleeding, pseudo-aneurysms
and dehiscence are reduced. The ascending aortic anastomosis
technique with aortic eversion is a simple procedure that may be
reliably preferred in aortic surgery, with reduced postoperative
complication rates.
The authors gratefully acknowledge the assistance provided by Temucin
Noyan OGUS in drawing the figures.
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