Clinical impact of turn-up anastomosis in the treatment of type A acute aortic dissection

Background: The management of anastomosis and hemostasis of the dissected aorta remains challenging. This study aims to establish an optimal surgical strategy for type A acute aortic dissection by reviewing single-center data using the turn-up anastomosis technique. Methods: Between 2003 and 2015, 264 consecutive patients with type A acute aortic dissection who underwent emergency surgery within 14 days of symptom onset were enrolled. Results: The mean age of the patients was 67.7 +/- 13.4 years, and 129 were males. The operative time and surgical bleeding were 390.9 +/- 144.5min and 2983.8 +/- 3026.5mL, respectively. In-hospital mortality was observed in 25 patients (9.4%), and 3 (1.1%) experienced uncontrolled bleeding (from the aortic root in two patients and coagulopathy due to dabigatran in one patient). Immediate reopening for bleeding was performed in 20 patients, and bleeding from the aortic anastomosis was observed at three proximal and two distal sites. Proximal re-dissection was observed in 18 patients; in all of which, glue was used, although two re-ruptures of the aortic root were observed among those without glue use. The rates of freedom from all-cause death, aortic death, and aortic events at postoperative 5 years were 78.5 +/- 2.7%, 86.8 +/- 2.1%, and 74.4 +/- 2.9%, respectively. When these values were stratified according to the operative extent, no significant differences were observed. Conclusions: Turn-up anastomosis facilitates short circulatory arrest, short operative time, and stable hemostasis, with few anastomotic complications during surgery for type A acute aortic dissection.