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Lizhong Sun M.D. Anzhen Hospital of Capital Medical University Beijing Aortic Disease Centre

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation. Lizhong Sun M.D. Anzhen Hospital of Capital Medical University Beijing Aortic Disease Centre. Background.

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Lizhong Sun M.D. Anzhen Hospital of Capital Medical University Beijing Aortic Disease Centre

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  1. One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseasesOpen stented elephant trunk technique combined with cardiac operation Lizhong Sun M.D. Anzhen Hospital of Capital Medical University Beijing Aortic Disease Centre

  2. Background What is the BEST therapeutic strategy? Patients with both type B Aortic dissection and cardiac diseases

  3. Patients and Materials Time: Apr. 2007 —— Mar. 2010 Patients Number：16 Type B AoD with cardiac disease Mean Age：49.75±13.42 years (range 17-64 years) Gender：12 male， 4 female Maximal Diameter：5.43±0.88cm (range 4.2-7.7cm, descending) Phase：3 Acute，13 Chronic Cardiac diseases：5 AI，4 ARA，6 Ascending AA，2 MI，3 AAD 1 TI，1 ASD，2 Marfan AI: aortic valve insufficiency; AAR: aortic root aneurysm; AA: aortic aneurysm; MI: mitral valve insufficiency; AAD: ascending aortic dilation; TI: tricuspid valve insufficiency; ASD: atrial septal defect

  4. Operative Techniques ACP via RAxA Bentall procedure Stented graft ACP: antegrade cerebral perfusion, RAxA: right axillarry artery

  5. Operative Techniques

  6. Operative Techniques LSCA was involved by aortic dissection Alternative strategy AAo → LSCA or LSCA→LCCA AAo： ascending aorta， LSCA：left sunclavian artery， LCCA：left common carotid artery

  7. Results No perioperative deaths, No perioperativecomplications CPB: cardiopulmonary bypass, SACP: selective antegrade cerebral perfusion, ICU: intensive care unit

  8. Results 3 urgent operations；13 elective operations Concomitant cardiac operations: 4 Bentall，2 Wheat，2 AVR+ AAo plasty， 4 AAo replacement，1 AVR，1 AAo plasty， 1 ASD repair+TVP+MVP，1 MVR Before surgery 3 months after surgery AVR: aortic valve replacement, AAo: ascending aorta, ASD: atrium septal defect, TVP: tricuspid valve plasty, MVP: mitral valve plasty, MVR: mitral valve replacement

  9. Disscussion • Indications：complicated type B AoD with cardiac diseases • complicated type B AoD involving distal arch • Marfan patients • Advantages：easy for operating; less injuries; one-stage • combined advantages of ET and TEVAR • Technique cautions：suturing technique • alternative strategy • Research limitations：limited pts number • retrospect research AoD: aortic dissection, ET: elephant trunk, TEVAR: thoracic endovascular aortic repair

  10. Conclusion • Open sET technique combined cardiac procedures can reliably treat Stanford type B AoD concomitant with surgical cardiac disease in single-stage sET: stented elephant trunk, AoD: aortic dissection

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