Intermittent horizontal mattress suture in proximal anastomosis for acute type A aortic dissection: a retrospective study.

Abstract

Objective: To compare intermittent horizontal mattress suture (IHMS) technique and conventional sandwich technique for proximal anastomosis in acute type A aortic dissection (ATAAD) surgery.

Methods: Patients who underwent ATAAD repair in our hospital between December 2020 and February 2023 were selected for inclusion in the study. The number of patients treated with the IHMS technique for aortic root repair were matched with those who received the conventional sandwich technique by the same surgeon. Perioperative and postoperative outcomes were analyzed and compared between the two groups.

Results: This study compared 44 patients in each group. The IHMS group had a shorter operation time than the sandwich group (6.07 h vs. 7.02 h, p = 0.018). The proximal anastomosis time (35.50 min vs. 40.00 min, p = 0.013), and extracorporeal circulation assistance time (70.00 min vs. 92.00 min, p < 0.001) were significantly reduced compared to the sandwich group. IHMS patients sustained less intraoperative blood loss (900 .00 mL vs. 1,500.00 mL, p = 0.005) and blood transfusion need (0 U vs. 0.75 U, p = 0.028) than patients in the sandwich group. Multivariate analysis revealed the IHMS technique to be independently associated with shorter suture time, less blood loss, and higher spontaneous heartbeat recovery. The IHMS group also had shorter durations of mechanical ventilation use, delirium, and hospital stay than the sandwich technique group. No statistically significant differences were found in postoperative morbidities during the follow-up period.

Conclusion: The IHMS technique for the aortic root anastomosis is simple, feasible and effective, particularly in ATAAD surgery with intimal rupture near the sinus-tubular junction to preserve the aortic valve during anastomosis of the ascending aorta.