Matrix-based repair of acute Type-A aortic dissections as an alternative to conventional glue repair

Objectives: The use of tissue-glues to repair disrupted layers during surgical repair of acute aortic dissections type-A (AADA) is often discontinuous, may not achieve sufficient reinforcement, entails the risk of redissection and embolisation and is costly. We report a concept of matrix based repair (MBR) of dissected aortic tissue with a collagen matrix double layer coated with fibrinogen/thrombin on either side (TachoSil ®; Nycomed). The matrix is converted into collagen within 3 months, thereby hypothetically creating a “neo-media”.

Methods: In 12 subsequent patients (7 male, 66.9±11.7 years) with acute AADA, undergoing ascending aorta replacement with an open distal anastomosis or aortic arch replacement, we performed MBR of the intima-media disruption at the proximal and distal anastomosis site. Care was taken that the collagen-matrix covered at least 2cm in depth and the whole dissected aortic circumference on either anastomosis. No glue was used to repair the dissected aortic wall in all patients. We recorded intraoperative parameters, as well as the clinical and radiological follow up until three months postoperatively.

Results: There was no intraoperative mortality, a total of 7.0±2.6 RBC, 3.4±1.5 platelets and 8.0±4.3 FFP were transfused. There was one perioperative death on postoperative day 23 due to a sudden secondary haemorrhage and pericardial tamponade. There were no major neurological deficits. Recovery in the surviving patients was satisfactory, mean ICU stay was 13.6±6.0d, mean hospital stay was 20.7±4.4d. On follow up three months postoperatively all but one patient were in god general condition and had returned to everyday life. In all 7 DeBakey II dissections the intimal tear was completely resected, in one DeBakey I dissection the false lumen in the descending aorta was completely collapsed. No re-dissections, no significant aneurysmatic dilatations and no aortic valve insufficiencies were seen.

Conclusions: The present analysis shows that collagen-matrix based repair of the dissected aortic tissue is feasible and safe, no re-dissections or dilatations at the site of the MBR occurred. The strategy completely avoids the need for conventional glues and its intra- and postoperative risks and disadvantages. Future studies will clarify the potential of MBR to create a collagen “neo-media”, its durability and its long term outcome.