Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.