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