Division of Cardiovascular Surgery

Xijing Hospital, Xi’an, China

Management of Aortic Dissection----New Management of Aortic Dissection----New

classification and Mid-term results classification and Mid-term results

Dinghua Yi, et al

Criado Zonation ， 2005 (According to

stent graft, suitable for aneurysm)

Xijing Classification, 2006 （ According to

primary tear, suitable for dissection ）

Zones based on hybrid procedure

Zone 1

Zone 3Zone 4

Zone 4

From December 2001 to June 2009

525 patients (492 male, 33 female)

The average age of 49.2 years old (37 ~ 73)

Acute dissection 491

Chronic dissection

34

Materials and Methods

For dissection with primary tears in Zone 1 (+2,3,4), open surgery remains the gold standard (including Bentall, total arch

replacement, concomitant CABG etc.)

Frozen elephant trunk technique was applied in patients with multiple tears (Zone 1 +Zone 2,3,4)

Ascending aorta to bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears in Zone 2.

Bilateral common carotid artery bypass should be established before endovascular exclusion for primary tears located in the Zone 3.

TEVAR became the gold standard for dissection with primary tears in Zone 4

Results Mortality Rate Procedure related

Complications Heart failure Renal failure Cerebral insufficiency Infection Endoleak Hepatic insufficiency Iatrogenic dissection

6.7%

3.3%

2.1%

0.6%

0.4%

0.6%

1.1%

0.4%

Defining zones according to the tear location is useful for planning a hybrid approach

Zone 3 ：Carotid

Bypass+TEVAR

Zone 4: TEVAR

Zone 1 ：Ascending Aorta

Replacement

Zone 2 ：Ascending aorta Bypass +TEVAR

Discussion

• Jian Yang, Jian Zuo, Lifang Yang, and Dinghua Yi. Endovascular stent-graft treatment of thoracic aortic dissection. Interact CardioVasc Thorac Surg 2006;5:688-691.

• Liu JC, Zhang JZ, Yang J, Yi DH et al. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection. Cardiovasc Intervent Radiol 2008;6:151-6

• Jian Yang, Jincheng Liu, Dinghua Yi. Comparisons of two Hybrid Approaches in treating Complex Aortic Dissection. International Congress XXI on Endovascular Interventions. 2008.2.10-15 Phoenix, USA

Publications