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 • • • • Cohort study Single center 2013-2016 Extensive diseaes: Ascending Aneurysm/dissection + arch and descending aneurysm/ dissection • Staged or hybrid operations RESULTS • • • • • • • N= 16 M:F= 13:3 Average of age: 60.3 (40-76) Hypertension: 16 Diabetes Melitus: CAD: Past TEVAR: RESULTS • • • • • Asc repl + total debr : Asc and arch repl : 14 CABG: Staged: Average of stent number: RESULTS • 30-DAY mort : 1/16= 5.88% • Paraplegia: • Bleeding: RESULTS: FOLOW-UP • Thrombosis of dissected descending aorta: 100% • Follow-up (1-36mo): no endoleak, death (2nd year) • Survival (36mo):14/15= 93,33% Why not frozen elephant trunk? post TEVAR-Acute type A dissection • • • • • • 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 THANK YOU FOR YOUR ATTENTION