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. 2022 Jul 14:9:892516.
doi: 10.3389/fcvm.2022.892516. eCollection 2022.

Early Results of a Novel Hybrid Prosthesis for Treatment of Acute Aortic Dissection Type A With Distal Anastomosis Line Beyond Aortic Arch Zone Zero

Arash Mehdiani  1 , Yukiharu Sugimura  1 , Louise Wollgarten  1 , Moritz Benjamin Immohr  1 , Sebastian Bauer  1 , Hubert Schelzig  2 , Markus Udo Wagenhäuser  2 , Gerald Antoch  3 , Artur Lichtenberg  1 , Payam Akhyari  1
Affiliations

Early Results of a Novel Hybrid Prosthesis for Treatment of Acute Aortic Dissection Type A With Distal Anastomosis Line Beyond Aortic Arch Zone Zero

Arash Mehdiani et al. Front Cardiovasc Med. .

Abstract

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).

Keywords: AMDS; acute aortic dissection type A (AADA); aortic remodeling; frozen elephant trunk; hemiarch and aortic arch replacement.

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Conflict of interest statement

PA and MW have received speaker fees from Cryolife. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Morphology of different surgical procedure. Anastomosis was ether performed in zone I using a single tube graft for INA (A), or more distally using single tubes for the anastomosis of supra aortic vessels (B) or a branched prosthesis (C).
Figure 2
Figure 2
Comparison of CT-measurement. (A) Showing an enlargement of the true lumen (TL) and a decrease of the false lumen (FL) in zone III. Area of TL + FL did not changed. (B) TL showed a significantly bigger increase in T11 and a significant decrease of the FL. Area of TL + FL did not changed. (C) ratio of TL/TL + FL was postoperatively significant higher in both zones compared to preoperative CT. (D) total diameter showed no significant difference.
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