Mehdiani Arash, Sugimura Yukiharu, Wollgarten Louise, Immohr Moritz Benjamin, Bauer Sebastian, Schelzig Hubert, Wagenhäuser Markus Udo, Antoch Gerald, Lichtenberg Artur, Akhyari Payam
Department of Cardiac Surgery, Heinrich Heine University Duesseldorf, Düsseldorf, Germany.
Department of Vascular and Endovascular Surgery, Heinrich Heine University Duesseldorf, Düsseldorf, Germany.
Front Cardiovasc Med. 2022 Jul 14;9:892516. doi: 10.3389/fcvm.2022.892516. eCollection 2022.
Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (Ascyrus Medical Dissection Stent (AMDS) Hybrid Prosthesis, Cryolife/Jotec, Hechingen, Germany) can be easily implanted to stabilize the true lumen (TL), improve remodeling, and preserve organ perfusion. Although developed for implantation in aortic zone 0, occasionally, partial replacement of the aortic arch and further distal implantation of AMDS may appear favorable. Implantation of AMDS with anastomosis line beyond zone 0 has not been described yet.
Between 08/2019 and 12/2020, a total of = 97 patients were treated due to AADA at a single University hospital. Of those, = 28 received an AMDS hybrid prosthesis, of whom in eight patients, due to intraoperative finding the distal anastomosis line was placed distal to the brachiocephalic trunk. Three patients had AMDS implantation in zone I and four were treated by implantation of the prostheses in zone II, and one patient had the implantation performed in zone III. Clinical outcome and the development of a proportional area of TL and false lumen (FL) at defined levels of the thoracic aorta were analyzed.
None of the surviving patients (87.5%) showed signs of clinical malperfusion (i.e., stroke, spinal cord injury, and need for dialysis). A postoperative CT scan showed an open TL in all patients. The proportion of TL with respect to total aortic diameter (TL+FL) was postoperatively significantly higher in zone III ( = 0.016) and at the level of T11 ( = 0.009). The mean area of TL+FL was comparable between pre- and postoperative CT-scan ( = n.s.). One patient with preoperative resuscitation died of multiple organ failure on extracorporeal life support on postoperative day 3.
Implantation of AMDS can be safely performed in patients who need partial replacement of the aortic arch beyond zone 0. The advantages of the AMDS can be combined with those of the total arch repair (remodeling of the arch and prevention of TL collapse) without the possible disadvantages (risk of spinal cord injury).
急性A型主动脉夹层（AADA）与围手术期高发病率和死亡率相关。一种新型无覆膜混合假体（Ascyrus Medical Dissection Stent（AMDS）混合假体，Cryolife/Jotec，德国黑兴根）可轻松植入，以稳定真腔（TL）、改善重塑并维持器官灌注。尽管该假体是为在主动脉0区植入而研发，但偶尔情况下，对主动脉弓进行部分置换并在更远端植入AMDS可能更具优势。目前尚未有关于在0区以外进行吻合线的AMDS植入的描述。
在2019年8月至2020年12月期间，一所大学医院共有97例患者因AADA接受治疗。其中，28例患者接受了AMDS混合假体植入，其中8例患者由于术中发现，远端吻合线位于头臂干远端。3例患者在I区植入AMDS，4例患者通过在II区植入假体进行治疗，1例患者在III区进行了植入。分析了临床结局以及在胸主动脉特定水平处TL和假腔（FL）的比例面积变化情况。
所有存活患者（87.5%）均未出现临床灌注不良迹象（即中风、脊髓损伤和需要透析）。术后CT扫描显示所有患者的TL均通畅。术后III区（P = 0.016）和T11水平（P = 0.009）处TL相对于主动脉总直径（TL + FL）的比例显著更高。术前和术后CT扫描之间TL + FL的平均面积相当（P = 无显著差异）。1例术前接受复苏的患者在术后第3天因多器官功能衰竭死于体外生命支持。
对于需要在0区以外对主动脉弓进行部分置换的患者，可安全地植入AMDS。AMDS的优势可与全弓修复的优势（弓部重塑和防止TL塌陷）相结合，而不存在可能的劣势（脊髓损伤风险）。
