AUTHOR=Tsutsui Masahiro , Ishidou Kouhei , Narita Masahiko , Usioda Ryohei , Kikuchi Yuta , Shirasaka Tomonori , Ishikawa Natsuya , Kamiya Hiroyuki TITLE=Modified turn-up technique for proximal anastomosis in acute aortic dissection type A has potential to facilitate stable outcomes for low-volume early-career surgeons JOURNAL=Frontiers in Surgery VOLUME=Volume 9 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.917686 DOI=10.3389/fsurg.2022.917686 ISSN=2296-875X ABSTRACT=Objective

Secure proximal anastomosis is an essential part of surgical treatment for acute aortic dissection type A (AADA). This study aimed to investigate the effectiveness of the modified turn-up technique for proximal anastomosis in AADA and compare this technique with other techniques.

Methods

We divided 57 patients who underwent ascending aorta replacement for AADA into the modified turn-up technique group (group A: 36 patients) and the other technique group (group B: 21 patients). Intraoperative and postoperative course data were compared between groups A and B. In group A, we also compared early-career surgeons (practicing for <10 years after graduation) and aged surgeons (practicing for ≥10 years after graduation).

Results

Preoperative patient characteristics did not differ between groups. There was a tendency toward shorter operation time in group A than in group B without statistical significance (p = 0.12), and the length of intensive care unit stay was significantly shorter (p < 0.01); the occurrence of cerebral infarction was lower (p < 0.01) in group A than in group B, whereas mortality and major complications other than the cerebral infarction rate did not differ between the groups. In group A, 13 patients were operated on by early-career surgeons, while 23 patients were operated on by surgeons with more than 10 years of experience. Aortic clamp time and circulatory arrest time were significantly longer in patients operated on by early-career surgeons, but outcomes were comparable.

Conclusions

The modified turn-up technique was comparable to other techniques. Even for less skilled surgeons (e.g., early-career surgeons), the use of this technique may lead to stable outcomes.