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

Patients with both type B Aortic dissection and cardiac diseases

Background

What is the BEST therapeutic strategy?

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

Operative Techniques

ACP via RAxA

Stented graft

Bentall procedure

ACP: antegrade cerebral perfusion, RAxA: right axillarry artery

Operative Techniques

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

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

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

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

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