Single-Stage Management of Dynamic Malperfusion Using a Novel Arch Remodeling Hybrid Graft.

Abstract

Organ malperfusion remains challenging, causing complications associated with acute DeBakey I dissections. We describe the results of malperfusion management after implantation of the Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL), an adjunct to current surgical aortic dissection repair. From March 2017 to January 2019, 47 consecutive patients (median age, 65 years; interquartile range, 15.8 years; 61.9% male) presented with acute DeBakey I aortic dissections and underwent emergent surgical aortic repair with AMDS implantation. Malperfusion was detected preoperatively in 55.3% (n = 26) of patients. Two patients were excluded from efficacy analysis due to lack of follow-up. Overall, 66 vessel malperfusions were identified, consisting of 1.5% (n = 1) coronary, 33.3% (n = 22) supraaortic, 21.2% (n = 14) visceral, 24.2% (n = 16) renal, and 15.1% (n = 10) extremities. Three patients (11.5%) had clinical evidence of paralysis at presentation. All 26 device implants were successful. In the malperfusion cohort, 30-day mortality was 7.7% (n = 2). A new neurologic deficit identified postoperatively in patients without neurologic symptoms preoperatively occurred in 7.7% (n = 2). During the follow-up period, 95.5% (n = 63) of vessel malperfusions had resolved without an additional procedure, including 95.5% (n = 21) supraaortic, 92.9% (n = 13) visceral, 93.8% (n = 15) renal, and 100% (n = 10) extremity. All patients with paralysis at presentation had complete resolution. The AMDS provides an effective single-stage malperfusion management strategy. In this study, dynamic malperfusion involving supraaortic, visceral, spinal cord, and lower extremities were treated concurrently with the index standard-of-care operation without delay in life-saving care.