A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report

Woon Heo,Youn-Ho Hwang,Ho-Ki Min,Jin Ho Choi,Hee Jae Jun,Do Kyun Kang,Jin Hong Wi

doi:10.1186/1749-8090-8-203

Abstract

Despite marvelous advances in repair for acute type A aortic dissection over past decades, it remains challenging to repair the aortic root when aortic dissection extended to the sinuses causes the fragile root because of its thinner layers, which are susceptible to suture trauma. Here, we describe a modified Florida sleeve technique to strengthen the weakened aortic root. After mobilization of the aortic root and the coronary arteries, a designed Dacron tube graft was wrapped outside the sinuses as neo-adventitia to reinforce the dissected weakened wall. During surgery for aortic dissection, our technique is easy and effective to reinforce a weakened root and avoid bleeding. Furthermore, this might be an alternative technique to restore and maintain the geometry of the aortic root.

Highlights

Acute type A aortic dissection remains a difficult to treat and catastrophic disease
Aortic dissection widely extended to the sinuses might to leave a thinner outer layer, which is susceptible to suture trauma and surgical bleeding
After the sleeve of a wrapping graft and the native aorta were cut off at the same level of the sinotubular junction, proximal graft-to-root anastomosis was completed with considering that full thickness suturing, together with the dissected aortic wall and a wrapping graft, is important for unifying the layers of the dissected aortic root

Summary

Background

Acute type A aortic dissection remains a difficult to treat and catastrophic disease. Aortic dissection widely extended to the sinuses might to leave a thinner outer layer, which is susceptible to suture trauma and surgical bleeding. Case presentation Two Korean patients with acute type A aortic dissection were performed operations using our modified technique, and the medical records were reviewed retrospectively. Cut off at the same level of the sinotubular junction, proximal graft-to-root anastomosis was completed with considering that full thickness suturing, together with the dissected aortic wall and a wrapping graft, is important for unifying the layers of the dissected aortic root. Post-operative echocardiogram revealed trivial aortic regurgitation in patient 1 (Figure 2A) and a well-functioning aortic prosthesis in patient 2. They remain asymptomatic for 3 months and 2 months respectively. Post-operative follow-up chest CT scans were performed and revealed the patent bypass grafts (Figure 2B)

Discussion

Conclusions