Combining aortic arch dissection stent implantation and root surgery for aortic dissection type A

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Medical Device Technology

Background:

• Acute aortic dissection type A (AADA) presents significant perioperative risks.
• A novel non-covered hybrid prosthesis (AMDS) offers potential for true lumen stabilization.
• The efficacy of AMDS in patients needing concurrent aortic root surgery remains underexplored.

Purpose of the Study:

• To evaluate the safety and feasibility of using the AMDS prosthesis in AADA patients undergoing aortic root surgery.
• To compare short-term outcomes between AADA patients treated with AMDS and a control group.

Main Methods:

• Retrospective analysis of 370 AADA patients from 2010-2020.
• Comparison of 120 patients undergoing aortic root surgery: 111 in the control group (proximal arch replacement) and 9 in the AMDS group (additional AMDS implantation).
• Outcomes assessed included aortic valve repair rates, operative times, and in-hospital morbidity (dialysis, stroke), mortality, and MACCE.

Main Results:

• Aortic valve repair rates were similar (48.6% Control vs. 55.6% AMDS).
• AMDS group experienced significantly longer cardiopulmonary bypass (313 vs. 248 min) and lower body circulatory arrest times (52 vs. 30 min).
• Postoperative outcomes including in-hospital mortality, dialysis, stroke, and MACCE were comparable between groups.

Conclusions:

• Implantation of AMDS for AADA with aortic root surgery extends operative times but does not adversely affect early postoperative outcomes.
• Combining aortic root surgery with proximal aortic arch replacement using AMDS is feasible and safe, demonstrating comparable early results to conventional methods.