Abstract:
Background: Acute type A aortic dissection is associated with a
significant perioperative morbidity and mortality. Ascyrus Medical
Dissection Stent (AMDS) is a novel bare stent graft developed to be used
as an adjunct to standard surgical approach to promote true lumen
expansion and therefor enhance aortic remodeling.
Patients and Methods: From March 2021 to March 2022, four
consecutive patients who presented with acute Debakey type I aortic
dissection underwent emergent surgical repair with an inclusion (David)
procedure and implantation of an AMDS. We analysed patient’s files
prospectively and described the perioperative outcomes.
Results: All four device implantations were successful. Overall
30-day mortality was 0 %. Malperfusion that was present in two patients
pre-operatively improved after AMDS implantation. At follow up, no
aortic reinterventions were needed. No aortic injury related to the
device was noted. Favourable changes in aortic true lumen and false
lumen dimensions were found in most of our patients but the AMDS was
compressed at the isthmus in one patient.
Conclusion: AMDS is a reliable and secure device. However, its
benefits remain unclear when it comes to a positive remodeling and seems
less likelihood comparable to a frozen elephant trunk. The main reason
seems to be an insufficient radial force of the AMDS.
Key Words: Acute Aortic Dissection, AMDS, Remodeling
Introduction:
Acute Debakey type I aortic dissection is a debilitating disease that
may be complicated by organ malperfusion in 30% to 40% and carries a
high mortality rate1-3. The standard surgical repair
by hemiarch or arch reconstruction using an open distal anastomosis
successfully manages the primary entry tear by resection; however, the
distal false lumen may remain perfused and subsequently pressurized and
the true lumen yet incompletely expanded. This may result in ineffective
treatment of malperfusion and over time by a growth of the aortic
diameter leading to repeated interventions, mainly on the descending
aorta.
The Ascyrus Medical Dissection Stent (AMDS, Artivion, Kennesaw, USA) is
a new device developed to be used in adjunct to current surgical aortic
dissection repair and is designed to improve short-term malperfusion
syndrome and supposed to lessen long-term aneurysmal evolution.
This hybrid prosthesis is composed of proximal PTFE felt sutureg line
attached to an uncovered Nitinol wire braided stent (figure1). Bozso et
al. have shown on the DARTS trial the security and feasibility of the
AMDS implantation, and the capacity of this device to improve aortic
remodeling4,5. Mehdiani et al. also showed that AMDS
can be safely performed in patients who need partial replacement of the
aortic arch beyond zone 06. We report the first French
implantation of the AMDS.