True Lumen Stabilization to Overcome Malperfusion in Acute Type I Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Techniques
• Aortic Dissection Management

Background:

• Acute type I aortic dissection (AD) with true lumen (TL) collapse and malperfusion presents a grave prognosis.
• Current surgical strategies for AD may not adequately address distal malperfusion.
• Restoring perfusion is critical for improving survival in complex AD cases.

Purpose of the Study:

• To evaluate the mid-term efficacy and safety of using uncovered stents to stabilize the TL in acute type I AD patients with malperfusion.
• To assess the role of TL stenting as an adjunct to proximal thoracic aortic surgery.
• To analyze outcomes including survival, false lumen patency, and aortic remodeling.

Main Methods:

• Retrospective analysis of 181 acute type I AD patients undergoing proximal aortic surgery between January 2007 and May 2017.
• Eighteen patients (10%) received uncovered stents to expand the TL for visceral and/or peripheral malperfusion.
• Procedures were performed in a hybrid operating room, combined with proximal repair and often frozen elephant trunk or descending aorta stent grafting.

Main Results:

• Indications for TL stenting included visceral (44%), peripheral (11%), or both (45%) malperfusion; 33% had additional stenting of aortic branches.
• Thirty-day mortality was 16.7%, and two-year survival was 71.8%.
• At a mean follow-up of 3.44 years, the false lumen remained patent in 89%, aortic diameter increased 0.1 cm/year, and neointima ingrowth was observed in one patient.

Conclusions:

• Combined endovascular-surgical procedures in a hybrid OR setting are safe and effective for resolving distal malperfusion in acute type I AD.
• Uncovered stent placement provides a stable foundation for subsequent endovascular techniques.
• This approach offers a viable solution for complex AD cases with true lumen collapse and malperfusion.