Sabin J Bozso1, Jeevan Nagendran1, Michael W A Chu2, Bob Kiaii2, Ismail El-Hamamsy3, Maral Ouzounian4, Jörg Kempfert5, Christoph Starck5, Ali Shahriari6, Michael C Moon7. 1. Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada. 2. Division of Cardiac Surgery, Western University, London, Ontario, Canada. 3. Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada. 4. Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada. 5. German Heart Centre, Berlin, Germany. 6. Ascyrus Medical, Boca Raton, Florida. 7. Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada. Electronic address: mmoon@ualberta.ca.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Igor Vendramin; Miriam Isola; Daniela Piani; Francesco Onorati; Stefano Salizzoni; Augusto D'Onofrio; Luca Di Marco; Giuseppe Gatti; Maria De Martino; Giuseppe Faggian; Mauro Rinaldi; Gino Gerosa; Davide Pacini; Aniello Pappalardo; Ugolino Livi Journal: JTCVS Open Date: 2022-03-26