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Ernesto R. Soltero
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Ann Thorac Surg 1998;65:1255-1259
© 1998 The Society of Thoracic Surgeons

Surgical Treatment of Aortic Dissections: Initial Experience With the Adventitial Inversion Technique

Raúl García-Rinaldi, MD, PhDa, Jorge Carballido, MDa, Joaquín Mojica, MDa, Ernesto R. Soltero, MDa, Slavisa Curcic, MDa, José Barceló, MDa, Raúl Porro, MDa

a Divisions of Cardiovascular Surgery, Anesthesia, and Perfusion, Pavía Heart Institute, San Juan, Puerto Rico

Accepted for publication December 5, 1997.

Address reprint requests to Dr García-Rinaldi, PO Box 19868, Fernández Juncos Station, San Juan, Puerto Rico 00910.
e-mail: garciarinald{at} isla.net

Background. The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears.

Methods. From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms. Three aneurysms were type I (A) involving the entire aorta, two type II (A) involving the ascending aorta, and one type III (B) involving the thoracoabdominal aorta. Circulatory arrest was used in 3 patients, 1 with type I aneurysm (A), 1 type II (A), and 1 type III (B).

Results. All Dacron–aorta anastomoses held sutures well and did not bleed intraoperatively or postoperatively. One patient (type II [A]) died of intraoperative low cardiac output. In patients with type I (A) aneurysms, the false lumen was obliterated, but 1 patient required resection of a 6-cm abdominal aortic aneurysm.

Conclusions. The adventitial inversion technique is a safe technique for the treatment of acute dissecting aneurysms, which facilitates operation and solves the problem of intraoperative or postoperative bleeding due to tissue friability.






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