Division of cardiovascular surgery xijing hospital xi an china
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Management of Aortic Dissection----New classification and Mid-term results . Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China. Dinghua Yi, et al. Zones based on hybrid procedure. Criado Zonation , 2005 (According to stent graft, suitable for aneurysm).

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

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Division of cardiovascular surgery xijing hospital xi an china

Management of Aortic Dissection----New classification and Mid-term results

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

Dinghua Yi, et al


Division of cardiovascular surgery xijing hospital xi an china

Zones based on hybrid procedure

Criado Zonation, 2005 (According to stent graft, suitable for aneurysm)

Xijing Classification, 2006 (According to primary tear, suitable for dissection )


Division of cardiovascular surgery xijing hospital xi an china

Zone 1

Zone 4

Zone 3

Zone 4


Division of cardiovascular surgery xijing hospital xi an china

Materials and Methods

  • 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


Division of cardiovascular surgery xijing hospital xi an china

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.)


Division of cardiovascular surgery xijing hospital xi an china

Frozen elephant trunk technique was applied in patients with multiple tears (Zone 1 +Zone 2,3,4)


Division of cardiovascular surgery xijing hospital xi an china

Ascending aorta to bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears in Zone 2.


Division of cardiovascular surgery xijing hospital xi an china

Bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears located in the Zone 3.


Division of cardiovascular surgery xijing hospital xi an china

TEVAR became the gold standard for dissection with primary tears in Zone 4


Division of cardiovascular surgery xijing hospital xi an china

Results

Mortality Rate

  • Procedure related

    Complications

  • Heart failure

  • Renal failure

  • Cerebral insufficiency

  • Infection

  • Endoleak

  • Hepatic insufficiency

  • Iatrogenic dissection

6.7%

3.3%

2.1%

1.1%

0.6%

0.6%

0.4%

0.4%


Division of cardiovascular surgery xijing hospital xi an china

Discussion

Defining zones according to the tear location is useful for planning a hybrid approach

Zone 2:Ascending aorta Bypass +TEVAR

Zone 3:Carotid Bypass+TEVAR

Zone 1:Ascending Aorta Replacement

Zone 4: TEVAR


Division of cardiovascular surgery xijing hospital xi an china

Publications

  • 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


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