Phối hợp stentgraft và mở hở với bệnh phồng lóc động mạch chủ

COMBINATION OF TEVAR AND OPEN REPAIR
FOR AORTIC DISSECTING ANEURYSMS

Nguyen Thai An, M.D
Chief, Department of Intensive
Care and Cardiac Surgery,
Cho Ray Hospital


Cho Ray hospital: in Ho Chi Minh,
South of Vietnam
- 1000 cases /year
Started TEVAR in 2012


Background
• Aortic disease : 1/10000
• Complex: CAD
• Extended: from root to bifurcation





76 yo man


Ascending aorta=43mm


AIMS OF STUDY

• ESTIMATE the results of open surgery
and TEVAR in extensive aortic
dissecting aneurysm


STUDY METHOD
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Cohort study
Single center
2013-2016
Extensive diseaes: Ascending
Aneurysm/dissection + arch and
descending aneurysm/ dissection
• Staged or hybrid operations


PROCEDURES
• Open suregry: ascending replacement
+ total debranching, ascending and
total arch replacement + elephant trunk
or not
• TEVAR retrogradely
• FOLLOW-UP : CT scan 3,6,12 months
post-op

RESULTS
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N= 16
M:F= 13:3
Average of age: 60.3 (40-76)
Hypertension: 16
Diabetes Melitus: 1
CAD: 1
Past TEVAR: 1


RESULTS
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Asc repl. + total debr. : 2

Asc and arch repl. : 14
CABG: 1
Staged: 2
Average of stent number: 2


RESULTS
• 30-DAY mort. : 1/16= 5.88%
• Paraplegia: 0
• Bleeding: 0


RESULTS: FOLOW-UP
• Thrombosis of dissected descending
aorta: 100%
• Follow-up (1-36mo): no endoleak, 1
death (2nd year)
• Survival (36mo):14/15= 93,33%


Why not frozen elephant trunk?


post TEVAR-Acute type A
dissection
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Female
45yo
Acute type B dissection
Left pleural effusion,
Partial ischemia of left kidney
TEVARs: descending thoracic, celiac
and SMA debranching+stent graft


First CT scan

Post TEVARs


New dissection type A



Conclusion
• Ascending aorta surgical replacement
combined with stented elephant trunk
has good mid- term outcomes