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Matrix-based repair of acute Type-A aortic dissections as an alternative to conventional glue repair
Tobias Kruger, Milan Lisy, Mahmud Kalhil, Czold Nagy, Ulrich A. Stock, Stephen M. Wildhirt.
University of Tuebingen, Tuebingen, Germany.
OBJECTIVE: The use of glues to repair intimal and medial disrupted layers during surgical repair of acute Type-A aortic dissections (AAD) is often discontinuous, may not achieve sufficient reinforcement and is costly. We report a highly effective method of matrix based repair (MBR) of dissected aortic tissue with a collagen matrix double layer coated with fibrinogen/thrombin on either side (TachoSil ®; Nycomed). It is known to be converted into autologous collagen within 3 months thereby creating an autologous neo-media.
METHODS: In 12 subsequent patients (7 male, 66,9±11.7 years) with acute AAD we performed MBR of the intima-media disruption at the proximal and distal anastomosis site intending to create an autologous collagen “neo media”. Care was taken that the MBR covered 1) at least 2-2.5 cm in depth and 2) the whole dissected aortic circumference on either anastomosis thereby respecting the geometry of the tissue to be repaired. Clinical outcome parameters, blood products used and CT-scans were analyzed. No glue was used to repair the dissected aortic wall in all patients.
RESULTS: Mortality was 0%, recovery was satisfactory, mean ICU stay was 13.6±6.0 d, mean hospital stay was 20.7±4.4 d. A total of 7.0±2.6 RBC, 3.4±1.5 platelets and 8.0±4.3 FFP were transfused. CT follow-up: In 7/7 DeBakey II dissections the intimal tear was completely resected, in 3/5 DeBakey I dissections the false lumen in the descending aorta was completely collapsed. No re-dissections and no aortic valve insufficiencies were seen during follow-up.
CONCLUSIONS: The present early analysis shows that MBR intended to create an autologous collagen “neo-media” of the dissected aortic tissue is safe and effective. The matrix based double layer collagen matrix coated with thrombin/fibrinogen results in continuous reinforcement of aortic tissue and completely avoids the need for conventional glues.The present early analysis shows that MBR intended to create an autologous collagen “neo-media” of the dissected aortic tissue is safe and effective. The matrix based double layer collagen matrix coated with thrombin/fibrinogen results in continuous reinforcement of aortic tissue and completely avoids the need for conventional glues.
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