Hybrid approach for type a aortic dissection
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Transcript of Hybrid approach for type a aortic dissection
Hybrid approach for type Aaortic dissection
Gian Luca Martinelli MDCV Surgery Dept.
S Anna Hospital – Catanzaro - Italy
Possible scenarios
• Complete resection of dissected aorta
• Total thrombosis in the false lumen
• Partial thrombosis in the false lumen
• Perfused false lumen
Shrinkage of the false lumen
Our goal: remodeling the aorta
• Extensive repair of the aorta should prevent chronic progressive enlargement of the false lumen and further aortic complications.
• Hybrid approach:
extend the treatment without increasing mortality rate.
Two surgical options• Multibranched Frozen Elephant Trunk :
Ascending-arch repair with multibranched grafting + descending aortic stenting
• Two-step approach:
① Ascending-arch repair with multibranched grafting
② Carotid-subclavian bypass + TEVAR
with ideal landing zone
The choice depends on clinical presentation, site of the intimal tear and patient age
Multibranched Frozen Elephant TrunkClinical Case 1
59 yo man
Acute aortic Type A dissection: arch entering tear
Not complicated (Penn Class Aa)
Surgical treatment:
Multibranched – FET with Captivia-Medtronic-VAMC 32-32-150
Preoperative MSCT scan
Guide wire in the true lumen
S. ANNA HOSPITAL – Photografic archive
FINAL RESULT
Two-step approachClinical Case 2
• 57 yo man;
• Pain, syncope and 3 h transient drowsiness (no neurological damages);
• TTE: severe IA, without pericardial effusion;
• CT scan: full rupture (tear) in sino-tubular junction and absence of malperfusion.
Preoperative MSCT scan
Case 2: surgical strategy
Bentall operation;
Aortic arch replacement in Z1;
Proximal reimplantation of cerebral vessels;
Creation of an optimal landing zone for TEVAR C-Tag Gore 34-34-200
SECOND STEP
Ideal landing in zone 0
FINAL RESULT
CONCLUSIONS
Decision making key points:Clinical presentation
Site of intimal tear
Age
Two surgical options:
FET or Hybrid two step approach
Thank you
Tips and Tricks
• Use of branched graft
• Anterograde deployement wire guided
• Very “proximal” distal anastomosis (Z 0-1) in shorter circulatory arrest time, mild hypothermia, anterograde selective cerebral perfusion
Most patients after surgery for AAD remain at risk for dissection-related
aortic complications
Repair of acute type A aortic dissection prevents further
procedures?