型夹层直视支架象鼻手术课件

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation,Lizhong Sun M.D. Anzhen Hospital of Capital Medical University Beijing Aortic Disease Centre,Patients with both type B Aortic dissection and cardiac diseases,Background,What is the BEST therapeutic strategy?,Patients and Materials,Time: Apr. 2007 Mar. 2010 Patiens Number：16 Type B AoD with cardiac disease Mean Age：49.7513.42 years (range 17-64 years) Gender：12 male， 4 female Maximal Diameter：5.430.88cm (range 4.2-7.7cm) Phase： 3 Acute，13 Chronic Cardiac diseases：5 AI，4 ARA，6 AAA，2 MI，3 AAD 1 TI，1 ASD，2 Marfan,AI: aortic valve insufficiency; MI: mitral valve insufficiency; AAA: ascending aortic aneurysm; TI: tricuspid valve insufficiency; ASD: atrial septal defect; AAD: ascending aortic dilation,ARA: aortic root aneurysm,Operative Techniques,ACP via RAxA,Stented graft,Bentall procedure,ACP: antegrade cerebral perfusion, RAxA: right axillarry artery,Operative Techniques,AAo： ascending aorta， LSCA：left sunclavian artery， LCCA：left common carotid artery,AAo LSCA or LSCALCCA,Operative Techniques,LSCA was involved by aortic dissection Alternative strategy,before surgery 3 months after surgery,3 urgent operations；13 elective operations Concomitant cardiac operations: 4 Bentall，2 Wheat，2 AVR+ AAo plasty， 4 AAo replacement，1 AVR，1 AAo plasty， 1 ASD repair+TVP+MVP，1 MVR,AAo: ascending aorta, AVR: aortic valve replacement, ASD: atrium septal defect, MVR: mitral valve replacement, TVP: tricuspid valve plasty, MVP: mitral valve plasty,Results,Results,No perioperative deaths, No perioperative complications,Disscussion,Indications：complicated type B AoD with cardiac diseases complicated type B AoD involving distal arch Marfan patients Advantages：easy for operating; less injuries; one-stage combined advantages of ET and TEVAR Technique cautions：suturing technique alternative strategy Research limitations：limited pts number retrospect research,AoD: aortic dissection, ET: elephant trunk, TEVAR: thoracic endovascular aortic repair,Conclusion,Open sET technique combined cardiac proced