Single stage hybrid repair for DeBakey Type I Aortic Dissection Col. Vassilios D Tzilalis MD, MSc, PhD Head of Vascular Surgery Department Lt Col. Ioannis P Panagiotou, MD, PhD Cardiothoracic Surgeon Col. Eleftherios S Chouliaras, MD Deputy Head of Anaesthesiology Department Lt Col. Ioannis G Kantounakis, MD Head of Interventional Radiology Department Col. Emmanouil G. Koutoulakis, MD, PhD Interventional Cardiology Department 401 General Army Hospital, Athens, Greece 1
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Single stage hybrid repair for DeBakey Type I Aortic Dissection · Single stage hybrid repair for DeBakey Type I Aortic Dissection Col. Vassilios D Tzilalis MD, MSc, PhD Head of Vascular
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Single stage hybrid repair
for DeBakey Type I Aortic Dissection
Col. Vassilios D Tzilalis MD, MSc, PhD
Head of Vascular Surgery Department
Lt Col. Ioannis P Panagiotou, MD, PhD
Cardiothoracic Surgeon
Col. Eleftherios S Chouliaras, MD
Deputy Head of Anaesthesiology Department
Lt Col. Ioannis G Kantounakis, MD
Head of Interventional Radiology Department
Col. Emmanouil G. Koutoulakis, MD, PhD
Interventional Cardiology Department
401 General Army Hospital, Athens, Greece1
Thoracic Aorta Dissections Type A or DeBakey I, II
67% 33%
60-75% 25-40%
1965
1970
2017 Stanford non A - non B ?
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
IRAAD 2018 IRAAD 2018
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Single stage hybrid repair for DeBakey Type I Aortic Dissection
Type B or DeBakey III
Osler W, Silverman ME, Murray TJ, Bryan CS. American College of Physicians. The quotable Osler , page 120.
Philadelphia: American College of Physicians, 2008
DeBakey Type I dissection: what a tragedy!
Aortic dissection is the most common catastrophe of the aorta,
2-3 times more common than rupture of the abdominal aorta.
When left untreated:
about 33% of patients die within the first 24 hours, and
50% die within 48 hours.
The 2-week mortality rate approaches 75%
in patients with undiagnosed ascending aortic dissectionIRAAD 2018, RS Elsayed, RG Cohen, F Fleischman, ME Bowdish. Acute Type A Aortic Dissection, Cardiol Clin 35 (2017) 331–345
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
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In early 2006, at age 97, DeBakey underwent surgery for a damaged aorta — a procedure he developed
Micheal DeBakey as a patient:
complicated DeBakey Type III - Stanford B dissection:
what an irony!
15 July 2008: died Friday night in Houston. He was 99
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
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Col. Vassilios D Tzilalis MD, MSc, PhD
Head of Vascular Surgery Department 401 General Army Hospital
Single stage hybrid repair for DeBakey Type I Aortic Dissection
Classes of recommendations
Levels of evidence
Ishimaru zones
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Single stage hybrid repair for DeBakey Type I Aortic Dissection
Stanford non A - non B
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital6
Single stage hybrid repair for DeBakey Type I Aortic Dissection
Stanford non A - non B
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
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Single stage hybrid repair for DeBakey Type I Aortic Dissection
when ET : Cardiothoracic surgeons
8Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
Single stage hybrid repair for DeBakey Type I Aortic Dissection
when FET: Cardiothoracic surgeons
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Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital
Single stage hybrid repair for DeBakey Type I Aortic Dissection
TEVAR in zone 0 after previous debranching
Where : Centralized in centres - Aortic experienced Teams
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital10
Case 1
Palm Sunday evening, 2019
female 58 from Airforce 251 General Hospital
acute DeBakey I (Stanford ? A)
threatened visceral - renal - limb ischaemia
bovine arch
Euroscore II: 11.12
pre op 128 CTA : 251 AirForce
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital11
Case 1 6-7 days before Orthodox Easter 2019
Female 58 from Airforce 251 General Hospital
Acute DeBakey I (Stanford non A - non B ?)
Threatened visceral - renal ischaemia
Bovine arch
Euroscore II: 11.12
extremely narrow
true lumenfalse
lumen
Stanford
non A -
non B ?
pre op 128 CTA: Osirix reconstruction
dissection flap
Col. Vassilios D Tzilalis MD, MSc, PhD , Head of Vascular Surgery Department 401 General Army Hospital12