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Today’s Standard Treatment for Acute Type A Aortic Dissection Isn’t Enough

Today’s Standard Treatment for Acute Type A Aortic Dissection Isn’t Enough

Type A Aortic Dissection (TAAD) presents itself emergently. Left untreated, mortality of type A dissection is reported to be approximately 1% to 2% per hour after onset of symptoms1 and can lead to 50% mortality in the first 48 hours.2

Type A Aortic Dissection (TAAD) presents itself emergently. Left untreated, mortality of type A dissection is reported to be approximately 1% to 2% per hour after onset of symptoms1 and can lead to 50% mortality in the first 48 hours.2

 Approximately 70% of entry tears occur in the ascending area.3 Surgical repair remains high-risk, with both mortality and neurological complication rates of 15% to 30%.1

Aortic aneurysm DeBakey Type 1
Aortic Hemiarch Repair

Aortic dissection is complex and difficult to treat.4,5 Hemiarch repair alone isn’t enough to stop a dissection from causing significant complications4-7 including:

  • High Mortality5,8 + Re-intervention6,8
  • Aortic Growth6,9
  • Malperfusion4,6 x
Aortic aneurysm DeBakey Type 1

 Approximately 70% of entry tears occur in the ascending area.3 Surgical repair remains high-risk, with both mortality and neurological complication rates of 15% to 30%.1

Aortic Hemiarch Repair

Aortic dissection is complex and difficult to treat.4,5 Hemiarch repair alone isn’t enough to stop a dissection from causing significant complications4-7 including:

  • High Mortality5,8 + Re-intervention6,8
  • Aortic Growth6,9
  • Malperfusion4,6 x

Consider the Implications of Distal Anastomotic New Entry (DANE) following a Standard Repair for Acute TAAD

Distal anastomotic new entry (DANE) in the standard hemiarch repair for TAAD is considered to be one of the causes of patent false lumen (PFL) after acute type I aortic dissection repair.9-12 DANE is observed in 40-70% of patients post hemiarch repair.6,10

Distal Anastomotic New Entry Picture

Consider the Implications of Distal Anastomotic New Entry (DANE) following a Standard Repair for Acute TAAD

Distal Anastomotic New Entry Picture

Distal anastomotic new entry (DANE) in the standard hemiarch repair for TAAD is considered to be one of the causes of patent false lumen (PFL) after acute type I aortic dissection repair.9-12 DANE is observed in 40-70% of patients post hemiarch repair.6,10

An Untreated DANE Can Lead to:

High Mortality

Survival with a patent false lumen gets significantly worse over the years, with a reduced actuarial survival by over 10% at 5 years and over 30% at 10 years compared to patients with occluded false lumen.11

Aortic Growth

A patent false lumen with DANE is associated with significantly greater aortic growth compared not only to a thrombosed false lumen, but also patent false lumen without DANE.9   

Malperfusion

Between 30-55% of all acute TAAD patients present with malperfusion.4,13,14 In-hospital mortality rate can be 5X higher in patients presenting with any malperfusion vs. patients presenting without malperfusion.13 At least 25% of patients have post-operative malperfusion syndrome.4

An Untreated DANE Can Lead to:

High Mortality

Survival with a patent false lumen gets significantly worse over the years, with a reduced actuarial survival by over 10% at 5 years and over 30% at 10 years compared to patients with occluded false lumen.11

Aortic Growth

A patent false lumen with DANE is associated with significantly greater aortic growth compared not only to a thrombosed false lumen, but also patent false lumen without DANE.9   

Malperfusion

Between 30-55% of all acute TAAD patients present with malperfusion.4,13,14 In-hospital mortality rate can be 5X higher in patients presenting with any malperfusion vs. patients presenting without malperfusion.13 At least 25% of patients have post-operative malperfusion syndrome.4

References:
1. Bonser et al. J Am Coll Cardiol 2011;58:2455–74.  2. Pepper J et al. Ann Cardiothorac Surg 2016;5(4):360-367. 3. Chin et al. J Am Coll Cardiol. 2018 June 19; 71(24): 2773–2785. 4. Nardi et al. Vessel Plus 2017;1:77-83.5. Merkle et al. Ther Adv Cardiovasc Dis 2018, Vol. 12(12) 327–340. 6. Rylski et al. Eur J Cardiothorac Surg 2017;51:1127–34. 7. Czerny et al. J Vis Surg 2018;4:14. 8. Shrestha  et al.. Eur J Cardiothorac Surg 2017;51:i34–i39. 9. Tamura et al Eur J Cardiothorac Surg 2017;52:867–73. 10. Bing et al Vascular and Endovascular Surgery 2014, Vol. 48(3) 239-245. 11. Fattouch et al Ann Thorac Surg 2009;88:1244–50. 12. Evangelista et al. Circulation. 2012;125:3133-3141. 13. Geirsson A, et al. Eur J Cardio-Thorac Surg, 2007;32(2):255-262.  14. Czerny M, et al. JACC 2015;65(24):2628-2635. 15. Instructions for Use (IFU), Ascyrus Medical Dissection Stent. 16. Journal Pre-proof of Bozso SJ et al. “Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial”, The Annals of Thoracic Surgery (2020), doi: https://doi.org/10.1016/ j.athoracsur.2020.05.090. 17. Lee TC et al. J Card Surg. 2018;33:7–18. 18. Easo J et al. J Thorac Cardiovasc Surg 2012;144:617-23. 19. Grimm JC et al. Ann Cardiothorac Surg 2016;5(3):202-208.  20. Dumfarth J et al. Eur J Cardiothorac Surg 2018;53:1013–2.