Use of AMDS in DeBakey Type I Aortic Dissection - A retrospective analysis of a single centre data & propensity match comparative analysis with Ascending Aorta Replacement

P0368 

Abstract Submission 

Ruhina Alam (1), Oluwanifemi Akintoye (1), Simon Strohmeier (2), RAVI DE SILVA (3)

(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom, (2) Medizinische Universitat Graz, Graz, Austria, (3) Royal Papworth Hospital NHS Foundation Trust, Leicester, Cambridgeshire

Ruhina Alam    -  Contact Me
Royal Papworth Hospital NHS Foundation Trust

Oluwanifemi Akintoye    -  Contact Me
Royal Papworth Hospital NHS Foundation Trust

Simon Strohmeier    -  Contact Me
Medizinische Universitat Graz

RAVI DE SILVA    -  Contact Me
Royal Papworth Hospital NHS Foundation Trust

Ruhina Alam    -  Contact Me
N/A

Stanford type A aortic dissection (TAAD) remains a life-threatening aortic event with high mortality rates. If the aortic arch is involved, either a hemiarch replacement (HAR) or a total replacement of the aortic arch (TAR) with implantation of a stent into the descending aorta (frozen elephant trunk -FET) is performed. Both HAR and TAR have their advantages and disadvantages. While TAR using FET is often considered to be the best way of sealing entry tears, perfusing arch vessels and supporting the expansion of the true lumen, it is a complex operation that involves a skilled, experienced team. On the other hand, HAR with an open distal anastomosis is technically simpler to perform and, therefore, within the repertoire of surgeons who do not have extensive experience of complex aortic arch surgery. However, some studies showed that HAR has an increased risk of aortic reintervention. Recently, there have been many attempts to address this problem, one of them is the Ascyrus Medical Dissection Stent (AMDS Hybrid Prothesis). This uncovered stent is intended to be implanted distal to an ascending aorta replacement and proximal to the brachiocephalic trunk (Zone 0) in cases of Type 1 acute aortic dissections. We present the early data of AMDS device in a single centre in the United Kingdom. We also present the results of propensity matched comparative analysis of AMDS and Ascending Aorta +/- Hemiarch replacement.
Data was collected retrospectively for a total of 20 patients who had AMDS device implanted for Type 1 Aortic Dissection in our centre from the period of March 1, 2022 – March 31, 2023, Data for 102 patients who underwent Ascending Aorta +/- Hemiarch replacement from 1 Jan 2018 – 31 March 2023, were also collected retrospectively to complete a propensity match analysis with the AMDS group.
During the period of 1 March 2022 – 31 March 2023, 66 patients had surgery for TAAD in our unit, out of which 20 patients (30.3%) had AMDS device. The 30-day mortality was 10% (n=2). This was comparable to the overall 30-day mortality of all dissection patients (N=66) during this time (13.64%, n=9). Postoperative CT scans were available in 17/20 patients (85%) and showed that the AMDS implantation and device expansion was successful in all patients (100%) with no device-related complications.
In the propensity matched analysis, there was no statistically significant difference between the overall mortality and 30-day mortality in between the AMDS & non-AMDS groups. There was also no statistically significant difference in length of ICU stay, prolonged respiratory support, post-operative AKI or need for CVVH or post-operative CVA/stroke between the AMDS group and non-AMDS group. However, there was a statistically significant difference in improvement in false lumen between the AMDS group and non-AMDS group (OR 2.13, 95% CI [0.69 – 3.78], P=0.006). Interpreted to mean that patients in the AMDS group had 2 times increase in improvement in false lumen compared to those in the control group. The 1-year survival rate in the AMDS group was 84.4% (95% CI 69.5% - 100%) compared to 85.0% (95% CI 70.7%-100%) in the non-AMDS group and this difference was not shown to be statistically significant (p=0.42)
Long term follow-up of patients with AMDS with serial imaging and comparative analysis is required to assess the long-term outcome, including any subsequent procedures required to treat the rest of the aorta and device-related complications.

Dissection