P381. Verification of distal anastomosis using adventitial inversion and interrupted sutures for Hemiarch replacement in Acute type A aortic Dissection that can be safely performed by Trainee
Prince of Wales Hospital
Shatin, New Territory - Contact Me
Dr.Takuya Fujikawa received medical training from Medical school of Tohoku university, Japan.
He undertook higher surgical training in cardiothoracic surgery in Yamagata Prefectural Central Hospital, Tohoku-Kouseinenkin Hospital, Kawasaki Aortic Center.
Dr. Fujikawa’s career interest focuses around open aortic surgery. He has been a staff surgeon of Kawasaki Aortic Center since 2011. Kawasaki Aortic Center is one of the highest volume aortic center in Japan which around 500 cases of open thoracic and thoraco-abdominal surgery were performed per year, including more than 120 cases of acute type A dissection. Dr Fujikawa has performed over 300 cases of open aortic surgery and supervised more than 300 cases of complex aortic surgeries to his junior trainee.
Dr. Fujikawa joined to Department of Surgery, Prince of Wales Hospital in Hong Kong as an Assistant Professor since February 2017 and has committed to expand the horizon of complex open aortic surgery in Hong Kong. Since July. 2018, he has been associate consultant and he is still actively involved in training of open aortic surgery in Prince of Wales Hospital, development of post-operative protocol for open descending aortic replacement and instrumental to decision making in Aortic Multidisciplinary Team monthly meeting.
Dr Fujikawa is currently a certificated cardiovascular surgery trainer of The Japanese board of Cardiovascular Surgery. And he is a member of Cardiothoracic Surgery Board of Japan, European Association of Cardio-Thoracic Society and Society of Thoracic Surgeons. He has presented in various National and International meetings including JSVS, Aortic Lives, TSVS, ASCVTS, EACTS and Aortic Symposium of AATS.
Description
Trainees have limited opportunities to gain surgical experience with acute type A aortic dissection (AAD) due to the high degree of urgency and high surgical mortality rate. Since 2017, our institution has introduced Adventitia Inversion + Interrupted Double Pledgetted Suture (AIDPS) for the distal anastomosis of hemiarch replacement (HAR) for AAD, and we have assigned young trainees to the AAD surgeon. We compared trainee's and senior surgeon's result.
【Method】
There were 238 cases of AAD surgery in our center between February 2017 and September 2023. we examined the surgical outcomes of 102 HAR cases in which distal anastomosis was performed with AIDPS.
As a general rule, distal anastomosis of HAR was performed under circulatory arrest at a rectal temperature of 25 Celsius degree. For cerebral protection, antegrade cerebral perfusion was given to one or two branches. The distal portion of the ascending aorta was trimmed leaving the adventitial side 1 cm longer than the intimal side, and anastomosed with interrupted sutures using 12 stitches of 4-0 Poly Vinylidene Fluoride with pledgets. First, 7 stitches were applied from the 3 o'clock direction to the 9 o'clock direction while inverting the adventitia on the native posterior wall side. These needles were placed on the posterior wall of the one branched graft. Next, lower this graft and five stitches were applied to the anterior wall from 10 o'clock to 2 o'clock. Subsequently, all stitches were tied circumferentially and the distal anastomosis was completed.
【Result】
The surgery was performed by Senior surgeon in 60 cases (S group) and by Trainee in 42 cases (T group). Surgical mortality was (S vs T = 3 cases, 5.0% vs 2 cases, 4.8% p=0.96). The mean time of circulatory arrest was (S vs T = 53.3 min vs 51.4 min p = 0.58), cerebral infarction (S vs T = 2 patients 3.3% vs 0 patients 0%, p = 0.51), and no re-operation for bleeding was observed. Distal Anastomosis induced New Entry was confirmed in 13 cases (12.7%)(S vs T = 6 cases, 10.0% vs 7 cases, 16.7% p=0.51). No significant difference was found in the 3-year survival rate (S vs T=85.9% vs 95.1%, p=0.19). There was no aorta-related deaths. 5 cases required additional aortic intervention(S vs T=4 vs 1).
【Conclusion】
Distal anastomosis of HAR for AAD using AIDPS was performed safely and reliably even when it was performed by trainees.
Authors
Takuya Fujikawa (1), Micky Wai Ting Kwok (2), Jacky Ho (3), Chi Ying Simon Chow (4), Kevin Lim (4), Song Wan (5), Randolph Wong (6)
Institutions
(1) Prince of Wales Hospital, Shatin, New Territory, (2) N/A, Hong Kong,, (3) Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NA, (4) N/A, N/A, (5) Prince of Wales Hospital, Hong Kong, Hong Kong, Hong Kong SAR, (6) Prince of Wales Hospital, N/A