division of cardiovascular surgery xijing hospital, xi’an, china management of aortic...
TRANSCRIPT
![Page 1: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/1.jpg)
Division of Cardiovascular Surgery
Xijing Hospital, Xi’an, China
Management of Aortic Dissection----New Management of Aortic Dissection----New
classification and Mid-term results classification and Mid-term results
Dinghua Yi, et al
![Page 2: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/2.jpg)
Criado Zonation , 2005 (According to
stent graft, suitable for aneurysm)
Xijing Classification, 2006 ( According to
primary tear, suitable for dissection )
Zones based on hybrid procedure
![Page 3: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/3.jpg)
Zone 1
Zone 3Zone 4
Zone 4
![Page 4: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/4.jpg)
From December 2001 to June 2009
525 patients (492 male, 33 female)
The average age of 49.2 years old (37 ~ 73)
Acute dissection 491
Chronic dissection
34
Materials and Methods
![Page 5: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/5.jpg)
For dissection with primary tears in Zone 1 (+2,3,4), open surgery remains the gold standard (including Bentall, total arch
replacement, concomitant CABG etc.)
![Page 6: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/6.jpg)
Frozen elephant trunk technique was applied in patients with multiple tears (Zone 1 +Zone 2,3,4)
![Page 7: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/7.jpg)
Ascending aorta to bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears in Zone 2.
![Page 8: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/8.jpg)
Bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears located in the Zone 3.
![Page 9: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/9.jpg)
TEVAR became the gold standard for dissection with primary tears in Zone 4
![Page 10: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/10.jpg)
Results Mortality Rate Procedure related
Complications Heart failure Renal failure Cerebral insufficiency Infection Endoleak Hepatic insufficiency Iatrogenic dissection
6.7%
3.3%
2.1%
0.6%
0.4%
0.6%
1.1%
0.4%
![Page 11: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/11.jpg)
Defining zones according to the tear location is useful for planning a hybrid approach
Zone 3 :Carotid
Bypass+TEVAR
Zone 4: TEVAR
Zone 1 :Ascending Aorta
Replacement
Zone 2 :Ascending aorta Bypass +TEVAR
Discussion
![Page 12: Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China Management of Aortic Dissection----New classification and Mid-term results Dinghua Yi,](https://reader036.vdocuments.mx/reader036/viewer/2022062407/56649ccc5503460f949969cb/html5/thumbnails/12.jpg)
• Jian Yang, Jian Zuo, Lifang Yang, and Dinghua Yi. Endovascular stent-graft treatment of thoracic aortic dissection. Interact CardioVasc Thorac Surg 2006;5:688-691.
• Liu JC, Zhang JZ, Yang J, Yi DH et al. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection. Cardiovasc Intervent Radiol 2008;6:151-6
• Jian Yang, Jincheng Liu, Dinghua Yi. Comparisons of two Hybrid Approaches in treating Complex Aortic Dissection. International Congress XXI on Endovascular Interventions. 2008.2.10-15 Phoenix, USA
Publications