1. Hybrid approach for type A
aortic dissection
Gian Luca Martinelli MD
CV Surgery Dept.
S Anna Hospital – Catanzaro - Italy

2. Possible scenarios
• Complete resection of dissected aorta
• Total thrombosis in the false lumen
• Partial thrombosis in the false lumen
• Perfused false lumen
Shrinkage of the false lumen

3. Our goal: remodeling the aorta
• Extensive repair of the aorta should prevent
chronic progressive enlargement of the false lumen
and further aortic complications.
• Hybrid approach:
extend the treatment without increasing mortality
rate.

4. Two surgical options
• Multibranched Frozen Elephant Trunk :
Ascending-arch repair with multibranched grafting
+ descending aortic stenting
• Two-step approach:
① Ascending-arch repair with multibranched grafting
② Carotid-subclavian bypass + TEVAR
with ideal landing zone
The choice depends on clinical presentation,
site of the intimal tear and patient age

5. Multibranched Frozen Elephant Trunk
Clinical Case 1
59 yo man
Acute aortic Type A dissection: arch entering tear
Not complicated (Penn Class Aa)
Surgical treatment:
Multibranched – FET with Captivia-
Medtronic-VAMC 32-32-150

6. Preoperative MSCT scan

7. Guide wire in the true lumen

8. S. ANNA HOSPITAL – Photografic archive

9. FINAL RESULT

10. Two-step approach
Clinical Case 2
• 57 yo man;
• Pain, syncope and 3 h transient drowsiness (no
neurological damages);
• TTE: severe IA, without pericardial effusion;
• CT scan: full rupture (tear) in sino-tubular
junction and absence of malperfusion.

11. Preoperative MSCT scan

13. Case 2: surgical strategy
Bentall operation;
Aortic arch replacement in Z1;
Proximal reimplantation of cerebral vessels;
Creation of an optimal landing zone for TEVAR C-Tag
Gore 34-34-200

14. SECOND STEP
Ideal landing in zone 0

15. FINAL RESULT

16. CONCLUSIONS
Decision making key points:
Clinical presentation
Site of intimal tear
Age
Two surgical options:
FET or Hybrid two step approach

17. Thank you

18. Tips and Tricks
• Use of branched graft
• Anterograde deployement wire guided
• Very “proximal” distal anastomosis (Z 0-1) in
shorter circulatory arrest time, mild
hypothermia, anterograde selective cerebral
perfusion

19. Repair of acute type A aortic
dissection prevents further
procedures?
Most patients after surgery for AAD
remain at risk for dissection-related
aortic complications