lizhong sun m.d. anzhen hospital of capital medical university beijing aortic disease centre
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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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
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Patients with both type B Aortic dissection and cardiac diseases
Background
What is the BEST therapeutic strategy?
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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
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Operative Techniques
ACP via RAxA
Stented graft
Bentall procedure
ACP: antegrade cerebral perfusion, RAxA: right axillarry artery
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Operative Techniques
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AAo : ascending aorta , LSCA : left sunclavian artery , LCCA : left common carotid artery
AAo → LSCA
or
LSCA→LCCA
Operative Techniques
LSCA was involved by
aortic dissection Alternative
strategy
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Results
CPB time (min) 131.62 ± 23.85 (100 - 177)
aortic cross clamping time (min) 64.69 ± 9.72 (47 - 78)
SACP time (min) 21.94 ± 3.60 (17 - 32)
Intubation time (hours) 15.27 ± 3.71 (9 - 20 )
ICU stay (days) 1-2
post operative in-hospital stay (days)
9.69 ± 2.85 (7 - 17 )
No perioperative deaths, No perioperative complications
CPB: cardiopulmonary bypass, SACP: selective antegrade cerebral perfusion, ICU: intensive care unit
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Before surgery
3 months after surgery
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
AVR: aortic valve replacement, AAo: ascending aorta, ASD: atrium septal defect, TVP: tricuspid valve plasty, MVP: mitral valve plasty, MVR: mitral valve replacement
Results
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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
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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