Less invasive surgical treatment for acute type A aortic dissection involving the arch Qian Chang, Yan Li, Xiaogang Sun, Xiangyang Qian, Cuntao Yu, Yizhen.

Slides:

Advertisements

Similar presentations

بسم الله الرحمن الرحيم.

Advertisements

Management of acute type b aortic dissection

William Beaumont Hospital Royal Oak, Michigan

Aortic Pathology Angioclub Case Alex Copelan M.D. William Beaumont Hospital October 24, 2013.

KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

(1) Arch Debranching vs. Elephant Trunk for Hybrid Repair of the Proximal Thoracic Aorta Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair.

Background (1) ・ In 1998, we developed a modified elephant trunk (ET) technique using a single four-branched arch graft with a sewing “collar” and “long.

Optimal Graft Diameter and Location Reduces Postoperative Complications Following Total Arch Replacement with a Long Elephant Trunk K. Taniguchi K.Toda.

Cardiosurgery - Skopje Surgery for acute aortic dissection using moderate hypothermia and antegrade cerebral perfusion via the right subclavian artery.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

STS 2015 John V. Conte, MD Professor of Surgery Johns Hopkins University School of Medicine On Behalf of the CoreValve US Investigators Transcatheter Aortic.

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

Conventional and frozen elephant trunk surgery for extensive aneurysmal disease of the thoracic aorta: a retrospective comparative study Marco Di Eusanio.

AORTIC DISSECTION Prof. Dr. Suat Nail ÖMEROĞLU. The most catastrophic disease of the aorta The most catastrophic disease of the aorta 5-10 patients/ 1.

Hybrid Repair of Kommerell’s Diverticulum

Results of “Type II” Hybrid Arch Repair with Zone 0 Stent Graft Deployment Jehangir Appoo, William Kent, Eric Herget, Jason Wong, Alberto Pochettino and.

ANESTHESIA FOR AORTIC SURGERY By: DR. Ahmed Mostafa Assist. Prof. of anesthesia Benha faculty of medicine.

HOW I DO IT ? MODIFIED NORWOOD’S OPERATION

Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

National Report Card on Hospital care for heart disease in Indigenous Australia Traven Lea, National Manager, Aboriginal and Torres Strait Islander Program.

Outcomes of 3309 Thoracoabdominal Aortic Aneurysm Repairs

Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E.

New York Aortic Surgery Symposium 2010 Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser The limited potential for.

P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?

The Use of Thoracic Endovascular Stent Grafting in Acute Aortic Tragedies as Compared to Open Surgical Repair Tyler J. Wallen, BA, Wilson Y. Szeto, MD,

Giampiero Esposito MD 2010-A-10-AATS Cardiovascular Surgery Unit CITTA’ DI LECCE HOSPITAL - ITALY GVM Hospitals of Care and Research Hybrid Approach to.

1 Wei Zhang, Wei-Guo Ma, Long-Fei Wang, Jun Zheng, Bulat A. Ziganshin, Paris Charilaou, Xu-Dong Pan, Yong-Min Liu, Jun-Ming Zhu, Qian Chang, John A. Elefteriades.

The assessment of the new hybrid procedure for extensive aortic aneurysms compared with the conventional open surgery Department of Cardiovascular surgery,

Without Deep Hypothermia

Sakakibara Heart Institute Minoru Tabata, MD, MPH, Akihito Matsushita, MD, Toshihiro Fukui, MD, Shigefumi Matsuyama, MD, Tomoki Shimokawa, MD, Shuichiro.

Osaka University Department of Cardiovascular Surgery Osaka University Department of Cardiovascular Surgery The efficacy of debranching TEVAR for arch.

Aneurysms of the innominate artery: surgical treatment of 27 patients. John D. Symbas, M.D., Michael E. Joseph B. Whitehead Department of Surgery, Division.

Pre-operative Cerebral Malperfusion in Patients with Acute Type A Aortic Dissection Involving the Supra-aortic Branches: Treatment and Early Outcome Maximilian.

Surgery for Aortic Dissection Adrian E. Manapat, M.D.

ASCVTS 2011 Shaggy aorta & TEVAR 1 “Shaggy aorta” is a highly dangerous sign of TEVAR for aortic arch aneurysm “Shaggy aorta” is a highly dangerous sign.

Central Cannulation Strategy Via Left Thoracotomy in the Treatment of Chronic or Residual Type B Dissection Extent I Thoracoabdominal + Distal Aortic Arch.

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation.

Tenri Hospital Dept. Cardiovascular Surgery Tenri Hospital, Dept. of Cardiovascular Surgery Daisuke Nakatsuka, M.D. Kazuo Yamanaka, M.D., Ph.D. Acute Type.

Does Moderate Hypothermia Really Carry Less Bleeding Risk than Deep Hypothermia For Circulatory Arrest? A Propensity-Matched Comparison in Hemiarch Replacement.

Does Operative Technique of Performing Distal Anastomosis in Acute type A Dissection Affect Early And Late Clinical Outcomes? Sotiris C. Stamou, MD, Ph.D,

The Japan Cardiovascular Surgery Database Organization

TOTAL AORTIC ARCH REPLACEMENT WITH THORAFLEX HYBRID FROZEN ELEPHANT TRUNK PROSTHESIS: RESULTS OF FIRST 100 PATIENTS Malakh Shrestha, Heike Krueger, Tim.

PREDICTORS FOR IN HOSPITAL MORTALITY IN PATIENTS WITH TYPE A AORTIC DISSECTION FROM A TWO CENTRE EXPERIENCE S Leontyev, J Légaré, MA Borger, K Buth, AK.

The Reoperative Aortic Root: Degenerative Failure vs. Infectious Destruction – Outcomes of The “True Redo-Root” Reconstruction Rita K. Milewski, Arminder.

Imaging Experience of Type II Hybrid Aortic Arch Repair: Lessons learned from Zone 0 Debranching & Evolution to Zone 2 Arch Repair Vamshi Kotha, Eric J.

Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection Osaka University Graduate.

Objective Bleeding events are grave and sometimes life threatening complications after prosthetic valve replacement, especially in hemodialysis patients.

Hybrid Arch for Acute Type A Aortic Dissection

Hybrid Arch for Acute Type A Aortic Dissection

Concomitant valve sparing root remodeling with extra aortic ring annuloplasty and e-vita stented elephant trunk implantation Igor Rudez, Marko Kusurin,

LEFT SUBCLAVIAN ARTERY REVASCULARIZATION DURING DEBRANCHING PROCEDURE FOR ACUTE “TYPE A“ AORTIC DISSECTION USING THE LEFT INTERNAL MAMMARY ARTERY Thank.

Does Moderate Hypothermia Really Carry Less Bleeding Risk than Deep Hypothermia For Circulatory Arrest? A Propensity-Matched Comparison in Hemiarch Replacement.

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Thoracic Aortic Frontier: Review of Current Applications and Directions of Thoracic Endovascular Aortic Repair (TEVAR) Jehangir J. Appoo, MDCM, FRCSC,

Open Repair of Distal Aortic Arch and Proximal Descending Thoracic Aortic Aneurysm Using a Stepwise Distal Anastomosis Hitoshi Ogino, MD Operative Techniques.

Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients Malakh Shrestha,

Jay J. Idrees, MD Eric E. Roselli, MD Lars G. Svensson, MD

Clinical outcomes of different surgical approaches for proximal descending thoracic aneurysm involving the distal arch Hyun-Chel Joo, MD, Young-Nam Youn,

Endovascular repair of complicated chronic distal aortic dissections: Intermediate outcomes and complications Woong Chol Kang, MD, PhD, Roy K. Greenberg,

Joseph S. Coselli, MD, Peter Oberwalder, MD

Custom-Made E-Vita Graft for Frozen Elephant Trunk With Arch-First Technique Luca Bertoglio, MD, Alessandro Castiglioni, MD, Alessandro Grandi, MD, Tommaso.

George Matalanis, BSc, MB, MS, FRACS, Shoane Ip, MBBS, BMedSc, FRACS

Nicholas D. Andersen, MD, Michael E. Barfield, MD, Jennifer M

Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair Adel Bin Jabr, MD, Bengt Lindblad, MD,

Anthony L. Estrera, MD, Charles C

G. Chad Hughes, MD, Mani A. Daneshmand, MD, Keki R

Surgical treatment of an aneurysm involving ascending aorta, aortic arch, and a rupture of a descending aortic aneurysm 26 years following acute type.

Presentation transcript:

Less invasive surgical treatment for acute type A aortic dissection involving the arch Qian Chang, Yan Li, Xiaogang Sun, Xiangyang Qian, Cuntao Yu, Yizhen Wei, Chuan Tian National Center for Cardiovascular Disease & Fuwai Hospital, Beijing, China

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Background Acute type A aortic dissection (ATAAD) involving the arch has high mortality and morbidity –Operative mortality ~20% Less complex procedures have traditionally been used –“Get in and get out” strategy – Distal aorta: aneurysmal dilatation or fatal rupture – 5-year need for reoperation 15-25% More extensive procedures are prompted –Total arch replacement + stented elephant trunk (TAR+SET) –Arch debranching + Arch TEVAR (Hybrid total arch TEVAR)

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Objective In patients presenting with ATAAD involving the arch, compare –Total arch repair + SET –Hybrid total arch TEVAR assess the fate of the distal aorta following extensive aortic repair procedures.

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Methods Large prospective database at our institution queried from 2009 to 2013 186 patients with ATAAD involving the arch underwent extensive aortic repair procedures - TAR+SET, n=136 - Hybrid arch repair, n=50 ATAAD involving the arch was defined as (1)with the primary tear in the transverse arch or the descending aorta (2)with aneurysm formation in the aortic arch or the distal aorta (>40 mm) (3)with the involvement of in the brachiocephalic artery.

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Right axillary artery cannulation with selective cerebral perfusion; DHCA Implantation of Stented elephant trunk TAR with a 4-branched graft aortic and epi-arch artery reconstruction Surgical Technique 1: TAR+SET Stented elephant trunk

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital CPB with mild hypothermia Ascending aorta replacement using a 4-branched graft Arch debranching and epi-arch artery bypass Surgical Technique 2: Hybrid arch repair, Surgical Part

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Through retrograde or antegrade access A self-expanding stent graft deployed distal to the origin of the side branches of the ascending aortic graft Surgical Technique 2: Hybrid arch repair, TEVAR Part

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Results – Patient Demographics Variables *p<0.05 Hybrid Group (N=50) TAR +SET Group (N=136) Median Age (y)*62 (55-75)47 (29-72) Gender-male39 (78.0%)111 (81.6%) Median Logistic EuroSCORE*13.68 ( ) ( ) Median EuroSCORE II (%)*8.71 ( ) 5.03 ( ) Etiology Hypertension44 (88.0%)111 (81.6%) Arthrosclerosis6 (12.0%)2 (1.5%) Genetically triggered023 (16.9%) Smoking29 (58%)89 (65.4%) Coronary artery disease*9 (18%)8 (5.9%) Congestive heart failure*6 (12%)9 (6.6%) Renal dysfunction*11 (22%)14 (10.3%) Chronic lung disease*10 (20%)13 (9.6%) Diabetes mellitus*8 (16%)7 (5.1%) Previous cerebrovascular disease*15 (30%)12 (8.8%)

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Results –Operative data Variables * p<0.05 Hybrid Group (N=50) TAR+SET Group (N=136) Repeat sternotomy1 (2.0%)3 (2.2%) Concomitant procedures Aortic valve repair14 (28.0%)32 (23.5%) Bentall procedure2 (4.0%)40 (29.4%) Wheat procedure03 (2.2%) Coronary Artery Bypass Grafting4 (8.0%)15 (11.0%) Femoral-femoral bypass2 (4.0%)21 (15.4%) Median operative time （ min ） Cardiopulmonary bypass time*130.7± ±35.7 Myocardial ischemia time*48.5± ±26.4 Selective cerebral perfusion timeNA24.6±8.4 Blood transfusion (red blood cells ） * 6u 9u

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Results –Short-term outcomes Short-term Outcomes Hybrid Group (N=50) TAR + SET Group (N=136) 30-d Mortality2 (4.0%)6 (4.4%) In-hospital mortality3 (6.0%)8 (5.9%) Stroke2 (4.0%)7 (5.1%) Paraparesis0 (0.0%)8 (5.9%) Permanemt paraplegia0 (0.0%)6 (4.4%) Injury to recurrent nerves0 (0.0%)5 (3.7%) New renal insuffiiciency9 (28.0%)33 (24.3%) Temporary hemodialysis5 (10.0%)21 (15.4%) Permanemt hemodialysis0 (0.0%)2 (1.5%) Reopearting for bleeding1 (2.0%)3 (2.6%) Need for tracheostomy3 (6.0%)10 (7.4%) Pulmonary infection10 (20.0%)28 (21.3%) Gastrointestinal bleeding / ischemia1 (2.0%)12 (8.8%) Poor wound healing / dehiscence0 (0.0%)3 (2.2%) Lower extremity amputation0 (0.0%)2 (1.5%) Graft Infection0 (0.0%)1 (0.7%) Median ICU Stay (d)4 (1-31)5 (1-40)

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Long-term results – Overall survival Kaplan-Meier curves for overall survival - TAR+SET - Hybrid arch repair Log-rank P=0.7

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Long-term results – Event-free survival Kaplan-Meier curves for MAEs-free survival MAEs = sudden death, stroke, aortic rupture, aortic reintervention - TAR+SET - Hybrid arch repair Log-rank P=0.3

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital - Cross-sectional CT scans during follow-up indicated thrombosis formation and expansion of the true lumen in the descending aorta. Upper row, Preoperative CT scan; Lower row, Postoperative CT scan.

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital Conclusions Hybrid arch repair demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with DHCA. This procedure has the potential to be an alternative for conventional total arch replacement for high-risk patients.

All Rights Reserved, Duke Medicine 2008 National Center for Cardiovascular Disease Fuwai Hospital