1. 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

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

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 Stented graft Bentall procedure ACP: antegrade cerebral perfusion, RAxA: right axillarry artery

5. Operative Techniques

6. 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

7. 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

8. 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

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