4/16/2015 The Aortic Case I Wish I Had Not Started Aka - PowerPoint PPT Presentation

4/16/2015 The Aortic Case I Wish I Had Not Started Aka Disclosures: • Research and educational grants paid to Stanford from The Case I wish I never would have Cook, Medtronic, WL Gore done… • No personal financial disclosures • Off Label use of devices Jason T. Lee UCSF Vascular Symposium 2015 VASCULAR SURGERY VASCULAR SURGERY Disclosures: Disclosures: Not my idea….. Not my idea….. Well, I guess that’s not true…. VASCULAR SURGERY VASCULAR SURGERY 1

4/16/2015 75 year old almond farmer presented in 2010 � with syncope/chest pain/pneumonia Noted to have 3.5cm ascending aortic dilation ◦ In followup in 2013 had recurrent chest � pain/SOB issues Imaging now shows ascending increased to 5.8cm ◦ Remainder of aorta scanned also showed 5.5cm dilation ◦ at hiatus and 7.2 cm juxtarenal Cardiopulmonary reserve limited � 269 pounds, BMI 40, sleep apnea 72% saturation ◦ FEV1 0.84L (29% predicted) ◦ Dilated left atrium, mild MR, TR, moderate AI, normal EF ◦ Discussed numerous times in clinic and � conference about risk/benefit VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 2

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 3

4/16/2015 open repair A. 33% hybrid debranching B. sandwich/snorkel/parallel C. 21% D. octopus 15% PMEG E. 9% 9% 9% IDE device F. 3% G. do nothing r l s G e g i g e u c a n E n l p i p i l M v i h a o h e r e c t P d t r n a c o p n a o E n e / r D o p b l e I d o e k d r o d n r i s / b y h h c i w d n a s VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 4

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 5

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4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY Now What???? VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 7

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 8

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 9

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY � Lessons ◦ Octopus configuration ◦ Parallel viabahns in gate VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 10

4/16/2015 VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY VASCULAR SURGERY 11