Treatment of acute type A aortic dissection with the Ascyrus Medical Dissection Stent in a consecutive series of 57 cases. (22nd December 2022)

• Record Type: Journal Article
• Authors: Luehr, Maximilian; Gaisendrees, Christopher; Yilmaz, Abdul Kadir; Winderl, Leila; Schlachtenberger, Georg; Van Linden, Arnaud; Wahlers, Thorsten; Walther, Thomas; Holubec, Tomas
• Is Part Of: European journal of cardio-thoracic surgery. Volume 63:Number 3(2023)
• Publication Date: 2022-12-22
• Subjects: Acute type A aortic dissection -- Ascyrus Medical Dissection Stent -- Aortic surgery -- Stent collapse -- Stent flattening -- gothic arch; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac581
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The Ascyrus Medical Dissection Stent (AMDS) has been recently introduced as an alternative for total arch replacement in acute aortic dissection type A (AADA). The aim of this study was to evaluate the postoperative outcomes after AMDS treatment in a large contemporary cohort of AADA patients. METHODS: Data acquisition was performed retrospectively at 2 German aortic centres between 2020 and 2022 and comprised the perioperative parameters and postoperative results of all AADA patients. All patients treated with the AMDS for AADA were included in the study. The primary end point was in-hospital mortality. Secondary end points were defined as early postoperative and AMDS-related complications. RESULTS: Fifty-seven AADA patients treated by AMDS were included in the study group. The mean age was 64.6 ± 10.8 years and 59.7% ( n = 34) were males. The actual in-hospital mortality was considerably lower than the predicted mortality risk by the German registry for acute aortic dissection type A score (16% vs 22%). The median ICU and in-hospital stay were 5 (interquartile range: 3–13) and 12 (interquartile range: 10–22) days, respectively. Postoperative complications comprised acute renal insufficiency (37%) with need for temporary (16%) or permanent dialysis (5%), delirium (26%), re-exploration for bleeding (14%), tracheostomy (14%) and new stroke (4%). A new AMDS-related complication (central stent collapse) was observed in 9% ( n = 5) by postoperative computed tomography and chest X-ray. The incidence of complete central AMDS collapse did not impact 30-day mortality. CONCLUSIONS: The AMDS may be successfully used in AADA with acceptable 30-day mortality in accordance with the German registry for acute aortic dissection type A score. However, careful preoperative evaluation of the patient's individual aortic anatomy regarding potential contraindications and proper device implantation are strongly recommended to avoid complete central AMDS collapse. Abstract : Acute aortic dissection type A (AADA) remains one of the most dreadful clinical emergencies with rapidly increasing mortality until diagnosis and immediate surgical treatment [1, 2].