de Manna Nunzio Davide, Helms Florian, Deniz Ezin, Kaireit Till Frederik, Abu-Fares Omar, Schmack Bastian, Ruhparwar Arjang, Weymann Alexander, Popov Aron Frederik
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Front Cardiovasc Med. 2024 Sep 26;11:1429287. doi: 10.3389/fcvm.2024.1429287. eCollection 2024.
Acute Type A aortic dissection (ATAAD) with supra-aortic branch (SAB) malperfusion remains a formidable clinical challenge, often resulting in high mortality and complex treatment dilemmas. The introduction of the AMDS represents a significant innovation, designed to stabilize the aortic arch, and manage malperfusion effectively.
This case study evaluates the utility of AMDS in the treatment of a 63-year-old male with hypertension, who presented with severe, acute chest pain. Diagnosed with a DeBakey type I ATAAD involving SAB, the patient underwent cardiopulmonary bypass, aortic root replacement, aortic arch repair with AMDS implantation, and subsequent endovascular stenting for severe left common carotid artery malperfusion that developed postoperatively. The AMDS was instrumental in facilitating crucial aortic arch reconstruction and addressing the initial severe malperfusion. Despite postoperative cerebral malperfusion, targeted endovascular stenting resulted in a rapid and substantial neurological recovery. The patient was discharged to a rehabilitation facility on postoperative day 20, free of neurological deficits.
The use of AMDS in managing ATAAD with SAB involvement is transformative, enabling less invasive surgical techniques and offering immediate, effective correction of malperfusion. This case underscores the essential role of integrating advanced endovascular strategies to enhance outcomes in high-risk aortic surgeries, marking a pivotal advancement in the therapeutic approach to complex aortic dissections
伴有主动脉弓上分支（SAB）灌注不良的急性A型主动脉夹层（ATAAD）仍然是一项严峻的临床挑战，常常导致高死亡率和复杂的治疗困境。主动脉夹层动态稳定系统（AMDS）的引入是一项重大创新，旨在稳定主动脉弓并有效处理灌注不良。
本病例研究评估了AMDS在治疗一名63岁高血压男性患者中的效用，该患者出现严重的急性胸痛。诊断为累及SAB的DeBakey I型ATAAD，患者接受了体外循环、主动脉根部置换、植入AMDS的主动脉弓修复术，以及随后针对术后出现的严重左颈总动脉灌注不良的血管内支架置入术。AMDS有助于进行关键的主动脉弓重建并解决最初的严重灌注不良问题。尽管术后出现脑灌注不良，但针对性的血管内支架置入术使神经功能迅速且显著恢复。患者于术后第20天出院至康复机构，无神经功能缺损。
在处理累及SAB的ATAAD时使用AMDS具有变革性，能够采用侵入性较小的手术技术，并能立即有效地纠正灌注不良。本病例强调了整合先进血管内策略以改善高危主动脉手术结局的重要作用，标志着复杂主动脉夹层治疗方法的关键进展
