Pro.Coselli: The first question is the aortic dissection， certainly an important clinical institute. And the question is the indications for emergency surgery changing for instance. It has been though the years a very important but difficult exercise for clinicians to select who to operate on rather away who to treat conservatively and operate on later. Clearly， patients who are symptomatic needs emergency surgery. We still firmly believe patients with the DeBakeyⅠ、Ⅱ， Stanford A， need emergency operation. But our question comes from whether the DeBakey Ⅲ， Stanford B， need this operation. Yet the most important thing that has developed is the use of instant stent grafting. while selecting this group of patients can be managed more effectively when concern the management， and we delay further intervention later if they need it.  This can be done in a combination of stent grafting or physical treating or blends grafting to ….. OK?
Joseph S Coselli教授：第一个问题是关于主动脉夹层，这当然是个很重要的临床问题。在这里要回答的问题是主动脉夹层进行急诊手术的指征是什么。确定哪些患者需要进行紧急手术，哪些患者可以先采取保守治疗然后再手术对临床医师而言一直是项艰巨而且重要的任务。显然，有症状的患者需要进行紧急手术。我们仍然坚信DeBakeyⅠ、Ⅱ， Stanford A型的主动脉夹层患者需要进行紧急手术。我们不怎么确定的问题是DeBakey Ⅲ， Stanford B型的是否需要这种手术呢。但是目前在这一领域出现了一项非常重要的发展，也就是即刻支架植入术的应用。采用这种新技术可以使患者得到更有效的治疗，因此，我们把有创性治疗拖延到必要的时候才进行。进行有创性治疗时，还可以将手术与支架植入等其他治疗方式联合使用。

<International Circulation>: OK， now， then the next question is Aortic root replacement？
《国际循环》：下一个问题是关于主动脉弓替换术？

Pro.Coselli: we don’t really distinguish between root replacement with or without aortic dissection. Their technique is quite similar. I think the important thing that comes along for both non-dissection and dissection  root replacement and the techniques that have been popularized by Tirone David， the arotic down specific technique， which we use extensively. So， before， we would use Bentall operation almost routinely. We now whenever possible ….we would use a David procedure. The specific one we use is the David Ⅰprocedure which is the inclusion technique， skilipe the …..
Joseph S Coselli教授：我们并不对伴有主动脉夹层和不伴有主动脉夹层的主动脉弓替换术进行区分。这两种情况下的手术在技术方面是非常相似的。我认为对主动脉夹层或非主动脉夹层的主动脉弓替换手术而言，最大的进步是Tirone David技术的广泛应用，我们也经常采用David技术。在此之前，我们可能常规采用Bentall手术，但是现在，只要患者病情允许，我们就会用David 术式。我们尤其常用的是David Ⅰ术式。

<International Circulation>: Now can you introduce something about your topic?
《国际循环》：您能简单介绍一下您的演讲内容吗？

Pro.Coselli: The most important thing which comes along recently regarding to Thoracoabdominal Aortic Aneurysms has been the revolution of technique for organ protection， specifically the kidney in extracorporeal but also the balance in brain and liver et al. We got a better sense of which patients need CSS drain and which don’t， which use laptop bypass which don’t. And another thing that comes along recent years which is extremely valuable has been the hybrid approaches where we use a combination of open-up operation and stent graft inclusion in Thoracoabdominal Aortic Aneurysms. That’s in beyond stage right now， but it’s rapidly， rappidly moving.
Joseph S Coselli教授：在胸腹主动脉瘤治疗方面最大的进步是器官功能保护技术的进步，尤其是体外肾功能及脑和肝脏代谢平衡方面进步。我们还可以更好的区分哪些患者需要进行动脉搭桥术，哪些不需要。近几年来，另一项在主动脉瘤方面极有价值的进步是开胸或开腹手术与支架植入术的混合应用。这种混合技术比较超前，但处在快速发展中。