Combination of tevar and open repair for aortic dissecting aneurysms

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