Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial

The PERSEVERE (ProspEctive, Single ARm, Multi-center Clinical InveStigation to EValuatE the Safety and Effectiveness of AMDS in the TREatment of Acute DeBakey Type I Dissection) Trial is a US investigational device exemption study designed to evaluate the Ascyrus Medical Dissection hybrid prosthesis in the open repair of patients with acute DeBakey type I dissection with preoperative malperfusion. We sought to determine the impact of false lumen (FL) communications within the supra-aortic vessels (SAV) on aortic remodeling by analyzing total aortic diameter (TAD), FL diameter, and true lumen (TL) diameter.

Ninety-three patients were enrolled from July 2022 to November 2023. Anatomic measurements were made by a core laboratory using computed tomography angiogram (CTA). For this study, analysis was limited to zones 2, 3, and 4. TAD was assessed on first postoperative CTA and at 1-year postoperatively, and growth was defined as >1.0 cm. In addition, the percent of patients with FL diameter larger than TL diameter were compared on the basis of the presence or absence of any FL communications in the SAV.

Fifty-five patients had a preoperative, first postoperative CTA, and 1-year CTA scan and were included in the analysis. SAV FL communications were present on preoperative computed tomography scan in 35% (19/55) and absent in 65% (36/55). In those with SAV FL communications, TAD growth occurred in 0%, 5.3%, and 21.1% in zones 2, 3, and 4, respectively. In those without SAV FL communications, TAD growth occurred in 2.8%, 2.8%, and 8.3% in zones 2, 3 and 4, respectively; the difference did not reach statistical significance. The FL was larger than TL in significantly more patients in zones 3 and 4 in those with compared with those without SAV FL communications (zone 3, 53% vs 18%; zone 4, 58% vs 18%; P < .05).

The presence of preoperative SAV FL communications has a significant impact on aortic remodeling at 1-year postoperatively. The presence of these communications is associated with a trend toward negative remodeling in zones 2, 3, and 4, in addition to a significantly larger FL compared with TL diameter, likely representing ongoing FL pressurization. Techniques to better identify SAV FL communications preoperatively may lead to a more tailored approach to operative management and more targeted postoperative surveillance in these patients.