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