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

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Presentation transcript:

Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi, et al Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Dear president, Good morning, ladies and gentlemen. It’s my great honor to be here, in scottsdale, to share our experience with everybody. Today my topic is ***.

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

Zone 1 Zone 4 Zone 3 Zone 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 From

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.)

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

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

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

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

Results Mortality Rate Complications Procedure related 6.7% 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%

Zone 1：Ascending Aorta Replacement 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 11

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