P046. Aortic Morphopathology in Therapy Decisions Using an Uncovered Hybrid Nitinol Stent for DeBakey I Dissections

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Aims: Hybrid treatment of acute DeBakey I aortic dissection (AD) using a conventional ascending replacement in combination with an uncovered nitinol Ascyrus Medical Dissection Stent (AMDS) enables a timesaving stabilization of the aortic wall with good clinical results. Despite proper use and stent sizing, considering D1 and D2 aortic diameters (figure 1), different stages of aortic remodeling – reaching from complete thrombosis to total patency of the false lumen (FL) at the level of the aortic arch and descending aorta – are seen in the follow-up. We aimed to determine the influence of aortic arch morphopathology on aortic remodeling.
Methods: Pre- and postoperative angiographic computed tomography (CT) data of 20 patients (20.4 ± 11.2 EuroSCORE II; 17.8 ± 7.1GERAADA score) who received a hybrid arch repair for DeBakey I AD between 04/2021 and 03/2023 were analyzed. Morphologic aortic arch types (type I, II and III) were defined according to the ratio between the LCCA-diameter and the distance from the horizontal line through the top of the arch to the horizontal line through the orifice of the innominate artery (figure 1). Volumetric measurements of the true (TL) and FL as well as the degree of FL thrombosis were assessed. Aortic remodeling was defined according to the FL volume index = FL volume/ (TL volume + FL volume). Finally, the degree of aortic remodeling was analyzed considering the morphologic aortic arch type. Primary endpoint was the degree of aortic remodeling after six month. Secondary endpoints were incidence of stroke, spinal cord ischemia and mortality.
Results: One permanent stroke (5%), one spinal cord ischemia (5%) but no malperfusion occurred postoperatively. The 30-day and 6-month mortality rates were 0% and 5%. The 6-month follow-up analysis of the remaining 19 patients revealed a 74% remodeling in the AMDS-covered part of the aorta: complete FL thrombosis in nine, and a partial FL thrombosis in five patients. Distal the AMDS a remodeling was seen in only 42%. Regarding the arch morphology, type I arches (n=10) showed a FL volume index decrease from 0.7 preoperatively to 0.08 postoperatively, with a remodeling in 80%. In type II arches (n=4) a complete remodeling was seen in 67%, whereas no reliable remodeling was seen in type III arches (n=6).
Conclusion: Indication for AMDS in DeBakey I AD should consider not only D1 and D2 aortic measurements for sizing, but also the aortic arch morphopathology for therapy decision. Although the significance of the present study is limited due to the small sample sizes, it seems that dissected type I arches may result with a complete aortic remodeling, whereas dissected type III arches are not best treated with AMDS.

Authors
Peter-Lukas Haldenwang (1), Markus Schlömicher (1), Chiara Bonnemann (2), Justus Strauch (1)
Institutions
(1) Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany, Bochum, Germany, (2) Departement of Radiology and Nuclear Medicine, University Hospital Bergmannsheil Bochum, Bochum, Germany

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