Adventitial inversion technique for type A aortic dissection distal anastomosis Tatsuya Oda, MD, Kenji Minatoya, MD, PhD, Hiroaki Sasaki, MD, PhD, Hiroshi.

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Adventitial inversion technique for type A aortic dissection distal anastomosis Tatsuya Oda, MD, Kenji Minatoya, MD, PhD, Hiroaki Sasaki, MD, PhD, Hiroshi Tanaka, MD, PhD, Yoshimasa Seike, MD, Tatsuya Itonaga, MD, Yosuke Inoue, MD, Junjiro Kobayashi, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 5, Pages 1340-1345 (May 2016) DOI: 10.1016/j.jtcvs.2016.01.018 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Postoperative 3-dimensional enhanced CT. A, Arrows indicate postoperative false lumen patency at remnant aorta. B, False lumen on the arch remains thrombosed with effective aortic reinforcement. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1340-1345DOI: (10.1016/j.jtcvs.2016.01.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Aortic reinforcement and distal anastomosis. A, The adventitia is trimmed to 1.0 cm longer than the level of the intimal edge. The redundant adventitia is then inverted into the aortic lumen and tacked to the luminal surface of the intima using 5-0 polypropylene running sutures at the level of the proximal aortic arch. B, The reinforced aorta is sutured end-to-end to a Dacron tubular graft using 4-0 polypropylene continuous suturing. The 4-0 polypropylene suture line is internal to the previous 5-0 polypropylene suture line to reduce the needle hole. C, Teflon felt is placed external to the adventitia and internal to the intima. The sandwich anastomosis is reinforced with 2 layers of 4-0 polypropylene interrupted mattress sutures. D, The reinforced aorta was then sutured end-to-end to a Dacron tubular graft using 4-0 polypropylene continuous sutures. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1340-1345DOI: (10.1016/j.jtcvs.2016.01.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Kaplan–Meier curves showing overall survival. Shaped areas represent 95% confidence limits. B, Survival between groups. Group A: adventitial inversion. Group S: sandwich method. Shaped areas represent 95% confidence limits. C, Aortic arch or descending aortic reoperation-free rate. During follow-up, 1 patient in group S required stent grafting for descending aortic aneurysm 3 years after initial operation. Shaped areas represent 95% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1340-1345DOI: (10.1016/j.jtcvs.2016.01.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Adventitial inversion versus felt sandwich method in AAD. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1340-1345DOI: (10.1016/j.jtcvs.2016.01.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions