P081. Clinical Outcome of the Distal Stump Construction Using Tailored Stand-up Collar Technique for Acute Type A Aortic Dissection

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Objective
Achievements of secure anastomosis and complete hemostasis are essential in the surgical treatment for type A acute aortic dissection (TAAD). In the present paper, we assessed the clinical feasibility of our tailored stand-up collar (TSC) technique, a simple technique for construction of the distal stump by pre-gluing felt strip with Hydrofit® during systemic cooling.
Methods
We enrolled 57 cases of isolated ascending aortic repair out of 143 cases of surgically repaired TAAD at our institution in the last decade. Patients were divided into three groups according to the technique for the distal stump construction; conventional (C) group in which only felt strip was used for reinforcement of the stump, 24 cases; post-aortotomy Hydrofit®️-felt (P) group in which a Hydrofit®️-applied felt strip was attached to the aorta after aortotomy, 18 cases; tailored stand-up collar technique (TSC) group in which a Hydrofit®️-applied felt strip was circumferentially placed on the aorta during systemic cooling, 15 cases. Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated between these three groups.
Results
Pre-operative characteristics, such as age, gender, comorbidities, and complications associated with TAAD were identical between the groups. In the P and TSC group, distal-first anastomosis and utilization of retrograde cardioplegia were more frequent compared with the C group. Duration of the open distal, cardiopulmonary bypass, hemostasis, and operation in the P and TSC group were significantly short compared with the C group. Furthermore, duration of the open distal in the TSC group (20 min) was significantly shorter compared with the P group (26 min). Post-operative transfusion volume of the packed red blood cells was significantly less in the TSC group. Post-operative additional procedure was less necessary in the TSC group. Post-operative hospital stay of the TSC group was significantly short and 40% of the patients were discharged within 2 weeks after operation.
Conclusions
Our tailored stand-up collar technique were feasible to reduce open distal and operation time, post-operative transfusion volume, additional procedure, and post-operative hospital stay.

Authors
Yukio Umeda (1), Shohei Mitta (2), Yukihiro Matsuno (2)
Institutions
(1) Gifu Prefectural General Medical Center, Gifu, Gifu, (2) Gifu Prefectural General Medical Center, Gifu, NA

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