A re-tightening suture technique for hemostasis during aortic root remodeling in chronic DeBakey type II aortic dissection

Abstract

We report a 45-year-old man with chronic DeBakey type II aortic dissection, a sinus of Valsalva aneurysm, and severe aortic regurgitation. His atopic dermatitis remained poorly controlled despite topical corticosteroids and injectable anti-inflammatory therapy and he occasionally experienced cutaneous bleeding from unconscious scratching during sleep. He therefore wished to avoid long-term anticoagulation. Valve-sparing root replacement using root remodeling with external annuloplasty was performed. Bleeding from the proximal continuous suture line was controlled using a re-tightening suture technique that lifted the bleeding point, facilitated placement of an additional mattress suture, and secured the redundant continuous suture under renewed tension. Postoperative imaging showed satisfactory root geometry and no residual aortic regurgitation. This technique may provide a simple and reproducible method for controlling difficult suture-line bleeding during root remodeling.