Key result
Implantation of the AMDS hybrid prosthesis beyond aortic arch zone 0 in patients with acute aortic dissection type A resulted in 87.5% survival without clinical malperfusion and significantly increased true lumen proportion.
Why the study?
Although developed for aortic zone 0, implantation of the novel non-covered AMDS hybrid prosthesis with an anastomosis line beyond zone 0 had not yet been described.
Does implantation of AMDS beyond zone 0 improve aortic remodeling and preserve organ perfusion in patients with acute aortic dissection type A?
Observational (n=8)
No
Does implantation of AMDS beyond zone 0 improve aortic remodeling and preserve organ perfusion in patients with acute aortic dissection type A?
p-value: p=0.016
Implantation of the AMDS hybrid prosthesis beyond aortic arch zone 0 is feasible and promotes early favorable aortic remodeling without increasing the risk of spinal cord injury in acute type A aortic dissection.
Initial AMDS experience beyond zone 0 appears feasible in AADA; leaves open need for prospective validation of remodeling and outcomes.
Introduction Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (Ascyrus Medical Dissection Stent (AMDS) Hybrid Prosthesis, Cryolife/Jotec, Hechingen, Germany) can be easily implanted to stabilize the true lumen (TL), improve remodeling, and preserve organ perfusion. Although developed for implantation in aortic zone 0, occasionally, partial replacement of the aortic arch and further distal implantation of AMDS may appear favorable. Implantation of AMDS with anastomosis line beyond zone 0 has not been described yet. Materials and Methods Between 08/2019 and 12/2020, a total of n = 97 patients were treated due to AADA at a single University hospital. Of those, n = 28 received an AMDS hybrid prosthesis, of whom in eight patients, due to intraoperative finding the distal anastomosis line was placed distal to the brachiocephalic trunk. Three patients had AMDS implantation in zone I and four were treated by implantation of the prostheses in zone II, and one patient had the implantation performed in zone III. Clinical outcome and the development of a proportional area of TL and false lumen (FL) at defined levels of the thoracic aorta were analyzed. Results None of the surviving patients (87.5%) showed signs of clinical malperfusion (i.e., stroke, spinal cord injury, and need for dialysis). A postoperative CT scan showed an open TL in all patients. The proportion of TL with respect to total aortic diameter (TL+FL) was postoperatively significantly higher in zone III (p = 0.016) and at the level of T11 (p = 0.009). The mean area of TL+FL was comparable between pre- and postoperative CT-scan (p = n.s.). One patient with preoperative resuscitation died of multiple organ failure on extracorporeal life support on postoperative day 3. Conclusion Implantation of AMDS can be safely performed in patients who need partial replacement of the aortic arch beyond zone 0. The advantages of the AMDS can be combined with those of the total arch repair (remodeling of the arch and prevention of TL collapse) without the possible disadvantages (risk of spinal cord injury).
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Mehdiani et al. (2022) conducted an observational in Acute aortic dissection type A (AADA) (n=8). Ascyrus Medical Dissection Stent (AMDS) Hybrid Prosthesis beyond zone 0 was evaluated on Proportion of true lumen (TL) with respect to total aortic diameter in zone III (p=0.016). Implantation of the AMDS hybrid prosthesis beyond aortic arch zone 0 in patients with acute aortic dissection type A resulted in 87.5% survival without clinical malperfusion and significantly increased true lumen proportion.
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