The use of the Ascyrus Medical Dissection Stent in acute type A aortic dissection repair reduces distal anastomotic new entry tear.

BACKGROUND: A distal anastomotic new entry tear (DANE) can occur at the time of surgical repair for acute type A aortic dissection (ATAAD). This study aims to compare the occurrence of DANE following a standard hemiarch repair to that following a hemiarch repair with an uncovered arch dissection stent.

METHODS: All patients who received a hemiarch repair or a hemiarch repair with an Ascyrus Medical Dissection Stent (AMDS) for ATAAD between 2017-2021 were included. Baseline, intra- and post-operative characteristics were collected. All available pre- and post-operative CT scans were analyzed. The primary outcome measures were the incidence of DANE, positive aortic remodeling, mortality, and aortic reintervention rates at last follow-up.

RESULTS: A total of 114 patients underwent repair of Debakey I ATAAD during the study period with either an isolated hemiarch (n=77) or hemiarch with an AMDS (n=37). There was no significant difference in mortality (p=0.768) or other in-hospital adverse events. During the follow-up period, DANE occurred in 43.3% (n=26) of the isolated hemiarch group and 11.8% (n=4) in the hemiarch plus AMDS group (p=0.002). The incidence of false lumen thrombosis and obliteration favored the AMDS group in the aortic arch (p=0.029), the proximal descending thoracic aorta (p=0.031) and level of pulmonary artery bifurcation (p=0.044).

CONCLUSIONS: The incidence of DANE is significantly reduced with the addition of an AMDS at the time of hemiarch repair for ATAAD repair. Further follow-up is necessary to identify late aortic complications that may have been prevented by reducing the incidence of post-operative DANE.