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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 UniversityBeijing Aortic Disease Centre Patients with both type B Aortic dissection and ca
2、rdiac diseases BackgroundWhat is the BEST therapeutic strategy? Patients and MaterialsTime: Apr. 2007 Mar. 2010 Patiens Number： 16 Type B AoD with cardiac diseaseMean Age： 49.7513.42 years (range 17-64 years) Gender： 12 male， 4 femaleMaximal Diameter： 5.430.88cm (range 4.2-7.7cm) Phase： 3 Acute， 13
3、ChronicCardiac diseases： 5 AI， 4 ARA， 6 AAA， 2 MI， 3 AAD 1 TI， 1 ASD， 2 Marfan AI: aortic valve insufficiency; MI: mitral valve insufficiency; AAA: ascending aortic aneurysm; TI: tricuspid valve insufficiency; ASD: atrial septal defect; AAD: ascending aortic dilation,ARA: aortic root aneurysm Operat
4、ive TechniquesACP via RAxA Stented graft Bentall procedureACP: antegrade cerebral perfusion, RAxA: right axillarry artery Operative Techniques AAo： ascending aorta， LSCA： left sunclavian artery， LCCA： left common carotid arteryAAo LSCA or LSCALCCA Operative Techniques LSCA was involved by aortic dis
5、section Alternative strategy before surgery3 months after surgery3 urgent operations； 13 elective operationsConcomitant 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 AAo: ascending aorta, AVR: aortic valve replacement, ASD
6、: atrium septal defect, MVR: mitral valve replacement, TVP: tricuspid valve plasty, MVP: mitral valve plasty Results ResultsCPB 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
7、stay (days) 1-2 post operative in-hospital stay (days) 9.69 2.85 (7 - 17 ) No perioperative deaths, No perioperative complications DisscussionIndications： complicated type B AoD with cardiac diseases complicated type B AoD involving distal arch Marfan patients Advantages： easy for operating; less in
8、juries; one-stage combined advantages of ET and TEVARTechnique cautions： suturing technique alternative strategyResearch limitations： limited pts number retrospect research AoD: aortic dissection, ET: elephant trunk, TEVAR: thoracic endovascular aortic repair ConclusionOpen sET technique combined cardiac procedures can reliably treat Stanford type B AoD concomitant with surgical cardiac disease in single-stage
B型夾層直視支架象鼻手術(shù)
