Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial

Q: What are the key findings of this study?

Preoperative supra-aortic vessel false lumen communications were associated with a significantly higher rate of false lumen diameter larger than true lumen diameter in zone 4 at 1 year compared to those without communications (58% vs 18%, P < .05).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute DeBakey type I aortic dissection with preoperative malperfusion (n=93). Intervention: Presence of supra-aortic vessel false lumen communications vs. Absence of supra-aortic vessel false lumen communications. Primary outcome: False lumen diameter larger than true lumen diameter in zone 4 at 1 year (p=<.05).

Q: What does this research mean for the field?

Preoperative supra-aortic vessel false lumen communications are associated with adverse aortic remodeling, resulting in significantly higher rates of false lumen diameter exceeding true lumen diameter in the descending thoracic aorta at 1 year after acute DeBakey type I dissection repair. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kyle W. Eudailey; Sabin J. Bozso; Shinichi Fukuhara; Fernando Fleischman; Ibrahim Sultan; W. F. Brinkman; Hiroo Takayama; Arminder S. Jassar; George J. Arnaoutakis; Michael C. Moon; Wilson Y. Szeto

doi:10.1016/j.xjse.2025.100081

October 9, 2025JTCVS structural and endovascular.Open Access

Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial

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Key result

Preoperative supra-aortic false lumen communications linked to ~3x higher rate of dominant zone 4 false lumen.

P<.05
n=93

Why the study?

The impact of false lumen communications within the supra-aortic vessels on aortic remodeling remained to be determined in patients undergoing open repair for acute DeBakey type I dissection.

Does the presence of preoperative supra-aortic vessel false lumen communications impact aortic remodeling at 1 year in patients undergoing acute DeBakey type I dissection repair with the AMDS hybrid prosthesis?

Study Design

Type

Cohort (n=93)

Blinding

Open-label

Multicenter

Yes

Structured PICO

Does the presence of preoperative supra-aortic vessel false lumen communications impact aortic remodeling at 1 year in patients undergoing acute DeBakey type I dissection repair with the AMDS hybrid prosthesis?

P

Population

55 adults (18-80 years old) with acute DeBakey type I aortic dissection and clinical and/or radiographic malperfusion who had preoperative, first postoperative, and 1-year CTA scans. Mean age 58.8 years, 83.6% male.

I

Intervention

Open repair with Ascyrus Medical Dissection Stent (AMDS) hybrid prosthesis in patients with preoperative supra-aortic vessel false lumen communications (n=19)

C

Comparator

Open repair with AMDS hybrid prosthesis in patients without preoperative supra-aortic vessel false lumen communications (n=36)

O

Outcome

Aortic remodeling at 1 year, assessed by changes in total aortic diameter (TAD), true lumen (TL) diameter, and false lumen (FL) diameter in zones 2, 3, and 4surrogate

Main Result

Absolute Event Rate: 58% vs 18%

p-value: p=<.05

Preoperative supra-aortic vessel false lumen communications are associated with adverse aortic remodeling and larger false lumens in the downstream aorta at 1 year after acute DeBakey type I dissection repair with the AMDS.

Limitations

Limited follow-up time of 1 year
Only 59% of enrolled patients had all required CT scans for inclusion
Small overall sample size
Subject to selection bias
Only 55 of the 93 enrolled patients had all required CT scans for inclusion

Implication

May warrant closer surveillance after DeBakey I repair; leaves open whether communications predict events or warrant intervention.

Abstract

Objective:The PERSEVERE (ProspEctive, Single ARm, Multi-center Clinical InveStigation to EValuatE the Safety and Effectiveness of AMDS in the TREatment of Acute DeBakey Type I Dissection) Trial is a US investigational device exemption study designed to evaluate the Ascyrus Medical Dissection hybrid prosthesis in the open repair of patients with acute DeBakey type I dissection with preoperative malperfusion.We sought to determine the impact of false lumen (FL) communications within the supra-aortic vessels (SAV) on aortic remodeling by analyzing total aortic diameter (TAD), FL diameter, and true lumen (TL) diameter.Methods: Ninety-three patients were enrolled from July 2022 to November 2023.Anatomic measurements were made by a core laboratory using computed tomography angiogram (CTA).For this study, analysis was limited to zones 2, 3, and 4. TAD was assessed on first postoperative CTA and at 1-year postoperatively, and growth was defined as >1.0 cm.In addition, the percent of patients with FL diameter larger than TL diameter were compared on the basis of the presence or absence of any FL communications in the SAV.Results: Fifty-five patients had a preoperative, first postoperative CTA, and 1-year CTA scan and were included in the analysis.SAV FL communications were present on preoperative computed tomography scan in 35% (19/55) and absent in 65% (36/ 55).In those with SAV FL communications, TAD growth occurred in 0%, 5.3%, and 21.1% in zones 2, 3, and 4, respectively.In those without SAV FL communications, TAD growth occurred in 2.8%, 2.8%, and 8.3% in zones 2, 3 and 4, respectively; the difference did not reach statistical significance.The FL was larger than TL in significantly more patients in zones 3 and 4 in those with compared with those without SAV FL communications (zone 3, 53% vs 18%; zone 4, 58% vs 18%; P < .05). Conclusions:The presence of preoperative SAV FL communications has a significant impact on aortic remodeling at 1-year postoperatively.The presence of these communications is associated with a trend toward negative remodeling in zones 2, 3, and 4, in addition to a significantly larger FL compared with TL diameter, likely representing ongoing FL pressurization.Techniques to better identify SAV FL communications preoperatively may lead to a more tailored approach to operative management and more targeted postoperative surveillance in these patients.(JTCVS Structural and Endovascular 2025;8:100081) Innominate artery false lumen communication as demonstrated on preoperative CT.

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Published by JTCVS structural and endovascular. · CC BY

Cite This Study

Eudailey et al. (2025) conducted a cohort in Acute DeBakey type I aortic dissection with preoperative malperfusion (n=93). Presence of supra-aortic vessel false lumen communications vs. Absence of supra-aortic vessel false lumen communications was evaluated on False lumen diameter larger than true lumen diameter in zone 4 at 1 year (p=<.05). Preoperative supra-aortic vessel false lumen communications were associated with a significantly higher rate of false lumen diameter larger than true lumen diameter in zone 4 at 1 year compared to those without communications (58% vs 18%, P < .05).

synapsesocial.com/papers/6a0500470a15aba660e45e81 https://doi.org/10.1016/j.xjse.2025.100081

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Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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