The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection?

Figures

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  Figure 1. Graphical example of the AMDS device (used with the permission of Artivion®, Atlanta, GA, USA). (A) AMDS, including the delivery system before implantation. (B) Fully unfolded AMDS. (C) Hemiarch replacement and AMDS implantation at zone 0.

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  Figure 2. Schematic of the step-by-step implantation of the AMDS (used with the permission of Artivion®, Atlanta, GA, USA). In summary, the steps are as follows: (A) Leave > 10 mm distance to the innominate artery and longer on the lesser curvature when transecting the ascending aorta (the diameter at the distal anastomosis should be >30 mm). Store the AMDS in saline solution until implantation; (B) Insert the AMDS into the true lumen until the cuff reaches the plane of the transected aorta (if a guidewire is used, remove it before stent expansion); (C) Remove the plastic sheath to expose the polytetrafluorethylene felt; (D) Place an external polytetrafluorethylene felt strip around the aorta, and then place four single non-interrupting polypropylene sutures beginning at 6 o’clock, followed by 12, 3 and 9 o’clock to stabilize the cuff. This sandwich technique is highly recommended to avoid tearing the dissected aortic tissue; (E) While stabilizing the felt, unscrew the green cap counterclockwise to remove it completely. Pull back the sutures to expand the stent portion; (F) The delivery system can be removed once the stent is fully expanded and the tip of the delivery system is free from…

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  Figure 3. Postoperative computed tomography-based 3D reconstruction showing central AMDS collapse.

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  Figure 4. Example of AMDS shortening, including cuff removal. (A) Application of multiple single non-interrupting polypropylene sutures to stabilize the stent frame. (B) Careful dissection of the felt cuff. (C) Cutting the stent frame. (D) Complete removal of the cuff without an uncontrolled expansion of the stent.