Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular.

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Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease Jehangir J. Appoo, MDCM, John Bozinovski, MD, Michael W.A. Chu, MD, Ismail El-Hamamsy, MD, PhD, Thomas L. Forbes, MD, Michael Moon, MD, Maral Ouzounian, MD, PhD, Mark D. Peterson, MD, PhD, Jacques Tittley, MD, Munir Boodhwani, MD, MMSc Canadian Journal of Cardiology Volume 32, Issue 6, Pages 703-713 (June 2016) DOI: 10.1016/j.cjca.2015.12.037 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Repair-oriented classification of aortic insufficiency (AI). SCA, subcommissural annuloplasty; STJ, sinotubular junction. Reprinted from Boodhwani et al.3 with permission from Elsevier. Canadian Journal of Cardiology 2016 32, 703-713DOI: (10.1016/j.cjca.2015.12.037) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Conventional total arch replacement as a technique for extended distal aortic reconstruction in acute type A aortic dissection. A branched Dacron graft is used for individual end-to-end anastomosis of the arch vessels. Image courtesy of Dr Jehangir Appoo. Reprinted from with permission from www.aorta.ca. Canadian Journal of Cardiology 2016 32, 703-713DOI: (10.1016/j.cjca.2015.12.037) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 3 Categories of emerging hybrid surgical and endovascular techniques of extended distal aortic reconstruction for acute type A aortic dissection. (A) Frozen stent graft with total arch replacement: at the time of circulatory arrest, the stent graft is placed through the open aortic arch in an antegrade fashion into the descending thoracic aorta. Total arch reconstruction is then performed with a branched Dacron graft and individual head vessel reimplantation. (B) Frozen stent graft with hemiarch replacement: at the time of circulatory arrest, the stent graft is placed through the open aortic arch in an antegrade fashion into the descending thoracic aorta. Next, a standard hemiarch replacement is performed leaving an intervening segment of native dissected arch. (C) Arch debranching: the ascending aorta is replaced and proximal rerouting of arch vessels is done with a branched Dacron graft. After weaning from cardiopulmonary bypass, the stent graft is deployed across the arch and into the ascending aortic Dacron graft. Fluoroscopy is used to identify and evaluate landing zones. Image courtesy of Dr Jehangir Appoo. Reprinted from with permission from www.aorta.ca. Canadian Journal of Cardiology 2016 32, 703-713DOI: (10.1016/j.cjca.2015.12.037) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 4 Zones of attachment in the thoracoabdominal aorta. Reprinted from Fillinger et al.125 with permission from Elsevier.125 Canadian Journal of Cardiology 2016 32, 703-713DOI: (10.1016/j.cjca.2015.12.037) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions