5. Bown MJ et al.Br J Surg 2002;89:7 14-30. Visser P 2005 Perioperative Period: Surgical mortality still elevated : 40 – 50% range Open Repair Overall mortality of 75 to 80%
6. Acute Type B Descending Dissection Asymptomatic What Perspective? Medical Rx Endograft Controversy Waiting for studies Our Data Symptomatic (malperfusion) Endovascular technology with some hybrid combinations
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8. Mortality Ruptured Cases All Pathologies TAA Intraop Death 4 (5.5%) 3(12.5%) < 30 Days 9 (12.3%) 5 (20.8%)
19. Type B Dissection, Regardless of Symptoms, Should Be Treated By Endografting to Prevent Future Complications?
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27. Z0 Z1 Z2 Z3 Z4 The Real Challenge: Conquering Zone Zero
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29. Acute Dissection Ascending Aorta Hematoma High Risk Patient for Open Procedure Balloon Occluding Device L. Coronary Artery Sheath with Positioning of ELG Aortic Valve Dissection
32. 1. Vortex velocity control in aneurysm 2. Laminates the flow in collaterals 3. Accelerates shear stress flow in the vessel Multi-Layered Stent Key Principles
41. We are the heritage of our undaunted medical forefathers. Our young physicians are the genetic products of those great pioneers. Let their fate be the product of those positive, energetic, inquisitive, creative, and adventurous epigenoms which have the ability to overcome all adversity and bring ultimate success to all endeavers.
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43. In All Aspects of Cardiovascular Therapy, the Pendulum is Swinging to Less Invasive Endovascular Approaches CABG Angioplasty Arrhythmia EP Aneurysm Endograft PVD Balloon & Stent ??? Carotid
44. Evolution of Endovascular Therapies has Created Expanded Opportunities- Created Uncertainties for the Future
46. Cardiovascular care is rapidly moving toward catheter-based technologies Surgeons lack skill set Obstacles Even more importantly they often do not recognize the complexity of endovascular
47. Often not available to surgeons- High-Quality Imaging is Imperative for High-Quality Results
48. The No Workshop Phenomenon Portable, suboptimum imaging will not be satisfactory for high performance outcomes Catheterization Laboratory
54. Hybrid Operating Rooms Hybrid Training Programs Hybrid Procedures A hybrid is a combination of two or more different things, aimed at achieving a particular objective or goal
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57. Ascending Aorta and Aortic Arch are the Next Generation of Challenges for Endoluminal Grafting
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59. Endovascular Techniques for Ascending & Aortic Arch Will be Coming Branched and Fenestrated Devices Not a Simple Process Other New Concepts
76. L. Subclavian A. Bovine Arch Graft to transposed aberrant right subclavian artery (37 yrs ago) Pseudoaneurysm Aberrant right subclavian artery with previous graft
77. L. C-S bypass Right C-S bypass Ligation of degenerated graft ELG deployment
78. Right C-S bypass L. C-S bypass Endoluminal graft Thrombosed pseudoaneurysm
84. Previous Type A Dissection Aberrant right subclavian artery Left CCA dissection Distal arch dissection False channel expansion Left subclavian dissection Left CCA dissection
93. Ascending graft Left common carotid bypass Innominate bypass Radiopaque marker for ELG landing zone
94. Ascending graft ELG ascending, arch, descending To left carotid, innominate Bifurcated graft Original ascending graft for type A repair To innominate
96. I. Aortic Valve II. Coronary Arteries III. Aortic Root IV. Ascending Aorta and Trunk Vessels
97. Current Potentials for Rx of Ascending Aortic Pathologies I. Degenerative Aneurysms Proximal landing length Distal landing length Proximal-distal discrepancies
98. II. Dissections Current Potentials for Rx of Ascending Aortic Pathologies Initial Tear 1-3cm Type II Extensive Dissection
99. Anatomic Challenge Larger Diameter Ascending Curvature Short Deployment Area Extremely Friable Tissue