Arch Bare Metal Stent Grafting in Type I Aortic Dissections After Hemiarch Repair

Area of Science:

• Cardiovascular Surgery
• Endovascular Therapy
• Aortic Disease Management

Background:

• DeBakey type I aortic dissections (AD) are often treated with hemiarch repair.
• A subset of patients experiences persistent distal end-organ ischemia due to true lumen (TL) compression.
• This study addresses the management of residual arch dissection and malperfusion post-hemiarch repair.

Purpose of the Study:

• To evaluate the efficacy of bare metal stent grafting for persistent TL compression after hemiarch repair in DeBakey type I AD.
• To assess the impact of the Zenith Dissection Endovascular Stent (ZDES) on TL dimensions and organ malperfusion.
• To determine the technical feasibility and outcomes of ZDES placement in this specific patient cohort.

Main Methods:

• Seven patients with type I AD and compromised distal TL underwent ZDES placement following hemiarch repair.
• The ZDES was deployed across the residual arch dissection, extending to the aortic bifurcation.
• Measurements included pressure gradients and true lumen (TL) and false lumen areas derived from CT scans.

Main Results:

• All 7 cases were technically successful, with no perioperative stroke or intraoperative death.
• A statistically significant increase in median TL area was observed at most measured locations.
• Pressure gradients between the ascending aorta and femoral access improved post-stenting.

Conclusions:

• Bare metal stenting across the aortic arch is a technically viable strategy for persistent distal TL compression after hemiarch repair.
• This approach may promote long-term aortic remodeling in patients with DeBakey type I AD and malperfusion.
• ZDES placement offers a potential treatment option for complex aortic dissections with distal malperfusion.