{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T04:16:36Z","timestamp":1769832996392,"version":"3.49.0"},"reference-count":21,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160\/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40\u2013198.8]) compared to the felt group (315 mL [IQR 285\u2013445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes.<\/jats:p>","DOI":"10.3390\/jcm14217736","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:21:46Z","timestamp":1762194106000},"page":"7736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Felt Versus Pericardium for the Sandwich Technique in Type A Aortic Dissection: A Human Cadaver Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jasmine","family":"El-Nashar","sequence":"first","affiliation":[{"name":"Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0374-8375","authenticated-orcid":false,"given":"Thomas","family":"Poschner","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2393-4900","authenticated-orcid":false,"given":"Mohamed","family":"El Din","sequence":"additional","affiliation":[{"name":"Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7618-9979","authenticated-orcid":false,"given":"Paata","family":"Pruidze","sequence":"additional","affiliation":[{"name":"Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgi","family":"Didava","sequence":"additional","affiliation":[{"name":"Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1597-720X","authenticated-orcid":false,"given":"Amila","family":"Kahrovic","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0575-0073","authenticated-orcid":false,"given":"Wolfgang J.","family":"Weninger","sequence":"additional","affiliation":[{"name":"Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2185-4895","authenticated-orcid":false,"given":"Daniel","family":"Zimpfer","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1114-5788","authenticated-orcid":false,"given":"Marek P.","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-8816","authenticated-orcid":false,"given":"Emilio","family":"Osorio-Jaramillo","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ezae039","DOI":"10.1093\/ejcts\/ezae039","article-title":"Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported","volume":"65","author":"Ede","year":"2024","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s12055-022-01351-0","article-title":"Plaster technique for filling up a future entry at the suture hole in type A aortic dissection","volume":"38","author":"Ishida","year":"2022","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1016\/S0003-4975(98)00214-8","article-title":"Performance of a safe proximal anastomosis in aortic dissection","volume":"65","author":"Pretre","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.xjtc.2023.10.026","article-title":"Adventitial inversion plus prosthesis eversion suture technique in surgical repair of acute type A aortic dissection","volume":"23","author":"Qin","year":"2024","journal-title":"JTCVS Tech."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.athoracsur.2004.08.028","article-title":"Long-term integrity of teflon felt-supported suture lines in aortic surgery","volume":"79","author":"Strauch","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.xjtc.2021.05.002","article-title":"Acute type A aortic dissection and the consequences of a patent false lumen","volume":"9","author":"White","year":"2021","journal-title":"JTCVS Tech."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.athoracsur.2016.10.048","article-title":"Type A Aortic Dissection Repair: How I Teach It","volume":"103","author":"Cohen","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yang, J., Li, X., Wu, M., Wu, J., Chen, Z., Sun, T., Fan, R., and Yu, C. (2022). Early and midterm results of valve-sparing aortic root reconstruction with a bovine pericardium patch for patients with acute type a aortic dissection. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1009171"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/S0003-4975(01)02663-7","article-title":"Use of \u201cBioGlue\u201d in aortic surgical repair","volume":"72","author":"Raanani","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/0003-4975(94)01018-8","article-title":"Adventitial inversion technique in repair of aortic dissection","volume":"59","author":"Floten","year":"1995","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"300060519871372","DOI":"10.1177\/0300060519871372","article-title":"The future of stenting in patients with type A aortic dissection: A systematic review","volume":"48","author":"Harky","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fang, C., Gao, S., Ren, X., Pang, X., Zhao, X., Ma, Z., Wang, C., and Liu, K. (2022). Comparison of two techniques in proximal anastomosis in acute type A aortic dissection. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1047939"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.xjon.2025.02.016","article-title":"Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperation","volume":"24","author":"Ahmad","year":"2025","journal-title":"JTCVS Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ezad426","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_15","unstructured":"El-Nashar, J., Pruidze, P., Unger, E., Schreiner, W., El Din, M., and Weninger, J.W. Novel Aortic Dissection Model in Human Cadaver. Manuscript submitted for publication 2025."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.ejcts.2005.08.029","article-title":"Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection","volume":"28","author":"Tanaka","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Miazza, J., Koechlin, L., Gahl, B., Berdajs, D., Vohringer, L., Eckstein, F., and Reuthebuch, O. (2024). Polytetrafluoroethylene Felt Inlay Neomedia and Tissue Glue Do Not Prevent Reoperation in Type A Aortic Dissection. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226663"},{"key":"ref_18","first-page":"289","article-title":"BioGlue cerebral embolism following acute type A aortic dissection repair","volume":"26","author":"Yamasaki","year":"2022","journal-title":"J. Cardiol. Cases."},{"key":"ref_19","unstructured":"Khonsari, S., Sintek, C., and Ardehali, A. (2008). Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, Wolters Kluwer Health\/Lippincott Williams & Wilkins. [4th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1536\/ihj.18-609","article-title":"A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery","volume":"60","author":"Zhu","year":"2019","journal-title":"Int. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/jocs.14005","article-title":"Training in cardiac surgery using human cadavers: Effectiveness of \u201cSilent Teachers\u201d","volume":"34","author":"Abro","year":"2019","journal-title":"J. Card. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7736\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:39:02Z","timestamp":1762195142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":21,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217736"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217736","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}