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Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China

Management of Aortic Dissection----New classification and Mid-term results. Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China. Dinghua Yi, et al. Zones based on hybrid procedure. Criado Zonation ， 2005 (According to stent graft, suitable for aneurysm).

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Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China

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  1. Management of Aortic Dissection----New classification and Mid-term results Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Dinghua Yi, et al

  2. Zones based on hybrid procedure Criado Zonation， 2005 (According to stent graft, suitable for aneurysm) Xijing Classification, 2006 （According to primary tear, suitable for dissection ）

  3. Zone 1 Zone 4 Zone 3 Zone 4

  4. Materials and Methods • From December 2001 to June 2009 • 525 patients (492 male, 33 female) • The average age of 49.2 years old (37 ~ 73) • Acute dissection 491 • Chronic dissection 34

  5. For dissection with primary tears in Zone 1 (+2,3,4), open surgery remains the gold standard (including Bentall, total arch replacement, concomitant CABG etc.)

  6. Frozen elephant trunk technique was applied in patients with multiple tears (Zone 1 +Zone 2,3,4)

  7. Ascending aorta to bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears in Zone 2.

  8. Bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears located in the Zone 3.

  9. TEVAR became the gold standard for dissection with primary tears in Zone 4

  10. Results Mortality Rate • Procedure related Complications • Heart failure • Renal failure • Cerebral insufficiency • Infection • Endoleak • Hepatic insufficiency • Iatrogenic dissection 6.7% 3.3% 2.1% 1.1% 0.6% 0.6% 0.4% 0.4%

  11. Discussion Defining zones according to the tear location is useful for planning a hybrid approach Zone 2：Ascending aorta Bypass +TEVAR Zone 3：Carotid Bypass+TEVAR Zone 1：Ascending Aorta Replacement Zone 4: TEVAR

  12. Publications • Jian Yang, Jian Zuo, Lifang Yang, and Dinghua Yi. Endovascular stent-graft treatment of thoracic aortic dissection. Interact CardioVasc Thorac Surg 2006;5:688-691. • Liu JC, Zhang JZ, Yang J, Yi DH et al. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection. Cardiovasc Intervent Radiol 2008;6:151-6 • Jian Yang, Jincheng Liu, Dinghua Yi. Comparisons of two Hybrid Approaches in treating Complex Aortic Dissection. International Congress XXI on Endovascular Interventions. 2008.2.10-15 Phoenix, USA

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