Management of Aortic Dissection----New
classification and Mid-term results
Dinghua Yi, et al
Division of Cardiovascular Surgery
Xijing Hospital, Xi’an, China
Zones based on hybrid procedure
Criado Zonation， 2005 (According to stent
Xijing Classification, 2006 （According to
graft, suitable for aneurysm)
primary tear, suitable for dissection ）
Zone 1
Zone 4
Zone 3
Zone 4
Materials and Methods
 From December 2001 to June 2009
 525 patients (492 male, 33 female)
 The average age of 49.2 years old (37 ~ 73)
 Acute dissection
 Chronic dissection
491
34
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
6.7%
Complications

Heart failure

Renal failure

Cerebral insufficiency

Infection

Endoleak

Hepatic insufficiency

Iatrogenic dissection
3.3%
2.1%
1.1%
0.6%
0.6%
0.4%
0.4%
Discussion
Defining zones according to the tear location is
useful for planning a hybrid approach
Zone 2：
Ascending aorta
Bypass +TEVAR
Zone 1：
Ascending Aorta
Replacement
Zone 3：Carotid
Bypass+TEVAR
Zone 4:
TEVAR
Publications
• 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