Refined suturing technique for graft-to-aorta anastomoses

BackgroundSecuring hemostasis at graft-to-aorta anastomoses represents a challenging feature of the surgical management of aortic pathologies, and can impact postoperative morbidity and mortality. A new refined suturing technique was developed to address this challenge.MethodsA Dacron tube graft of appropriate size is secured within the aortic lumen using a horizontal 4-0 Prolene U-stay suture, and its two arms are used to complete the anastomosis continuously. With every bite, the needle is driven horizontally across an outer circumferential felt strip and aorta (out-in), through the graft at a 2-3-mm distance from its edge (out-in), back through the graft at a 7-8-mm distance from its edge (in-out), and finally bridging over the aortic edge back to its outer aspect without piercing the aortic wall. The two running sutures are firmly tightened and knotted, and Bioglue is applied.ResultsThe described technique was used in 175 patients who underwent ascending aortic replacement for aortic aneurysm or acute dissection. We have found its application to be associated with improved hemostasis and reduced intraoperative and postoperative blood loss. Additional sutures were rarely needed for hemostasis at suture lines, and there were no incidents of false aneurysm formation at anastomosis lines on long-term follow-up.ConclusionsThe described technique is associated with improved hemostasis, reduced blood loss, and decreased operating time, ultimately bringing significant benefits to patients undergoing surgical management of aortic pathologies.