Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial
| Autor: | Michael C. Moon, Jeevan Nagendran, Ismail El-Hamamsy, Bob Kiaii, Jörg Kempfert, Maral Ouzounian, Christoph Starck, Michael W.A. Chu, Sabin J. Bozso |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch Aortic dissection medicine.medical_specialty business.industry medicine.medical_treatment Stent Lumen (anatomy) 030204 cardiovascular system & hematology Anastomosis medicine.disease Thrombosis Surgery 03 medical and health sciences Dissection 0302 clinical medicine 030228 respiratory system medicine.artery medicine Thoracic aorta Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 111:463-470 |
| ISSN: | 0003-4975 |
| Popis: | Background The intimal flap at the distal aortic anastomosis after standard aortic dissection repair creates distal anastomotic new entry, leading to false lumen (FL) pressurization and true lumen (TL) collapse and resulting in increased mortality, malperfusion, aortic growth, and reinterventions. The Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL) is a hybrid prosthesis that seals and depressurizes the FL at the distal anastomosis while expanding and pressurizing the TL. Methods The Dissected Aorta Repair Through Stent Implantation trial is a prospective, nonrandomized, international type A dissection trial where patients with acute DeBakey I dissections were enrolled between March 2017 and January 2019. Forty-seven patients were enrolled (median age, 62.5; 67.4% men) with a median follow-up of 631 days. Results All patients underwent emergent surgical repair with successful AMDS implantation. One patient was excluded because of use in iatrogenic dissection. Overall mortality at 30 days and 1 year was 13.0% (6/46) and 19.6% (9/46), whereas new strokes occurred in 6.5% (3/46). Over 95% of vessel malperfusions resolved because of AMDS-induced TL expansion, including 3 patients with preoperative paralysis. Positive remodeling of the aortic arch occurred in 100% of cases with complete obliteration or thrombosis of the FL in 74%. In the proximal descending thoracic aorta positive remodeling occurred in 77% and complete obliteration or FL thrombosis in 53% of cases. Conclusions AMDS facilitates single-stage management of malperfusion and induces positive remodeling of the aortic arch through effective sealing of the distal anastomotic FL, depressurization of the FL with expansion, and pressurization of the TL. Importantly the use of AMDS is safe and reproducible. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|