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Thoracic Aortic Diseases Treated With Modified Sutureless Endoluminal Anastomotic Rigid Ring Technique. Initial Experience Of Ten Consecutive Cases
RICARDO B. CORSO, Sr., Isaac Azevedo Silva, Sr., Elson Borges LIma, Sr..
Cardiovascular Associados, Brasília, Brazil.

OBJECTIVE: Many surgical advances have been recently added to the surgical treatment of thoracic aortic diseases to minimize peroperative morbidity and mortality. The use of sutureless rigid endoluminal anastomotic ring techniques with regular dacron grafts has long been described, but hardly ever used routinely due to previous published failures, like anastomotic pseudoaneurysm formation. A ring modification described by RC Bernardes at al. has shown easy and reproducible application, excellent long-term results, with no pseudoaneurism formation. We describe the surgical technique, immediate and short-term results of the first ten operated cases with the modified Castro Bernardes sutureless rigid endoluminal anastomotic ring.
METHODS: All the patients have been operated through midsternotomy and with extracorporeal circulation. Right axillary or carotid arteries were used as preferred perfusion return site. The modified endoluminal rigid anastomotic ring is made of Polyoxymethylene in different sizes. The sutureless grafting anastomosis to the aorta is made exclusively with triple polyester threads encircling the entire aorta wall. Ten consecutive patients were operated between October 2011 and September 2012. Eight patients were male. Average age was 57,1 years. Eight patients presented acute aortic dissection and two proximal aortic aneurisms. One patient had a previous cardiac surgery. Every patient received one endoluminal ring anastomosis except one who has received two rings.
RESULTS: There was no need for reintervention because of bleeding or any other cause. There was no operative death. One patient died (10%) in hospital due to anticoagulation complication (cardiac tamponade) and respiratory failure. One marfan like patient needed early descending aortic endografting due to distal residual dissection complication after discharge. The same patient needed surgical re-intervention due to aortic arch expansion in one-year follow-up. There was no anastomotic pseudoaneurysm formation during this early follow-up period.
CONCLUSIONS: The Castro Bernandes modified sutureless endoluminal rigid ring anastomosis has shown to be technically easy and reproducible in thoracic aorta disease treatment. This surgical technical option seems to reduce intraoperative and pump times and perioperative blood loss.


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