Today’s standard of treatment for type A dissection isn’t enough.
In the vast majority of cases, standard surgical repair leaves behind an anastomotic entry tear that continues to pressurize the false lumen.
The presence of dissected tissue at the distal anastomosis after standard surgical replacement leaves patients with an entry tear that allows antegrade pulsatile flow (APF) and pressurization of the false lumen. In the short term, this pressure can collapse the true lumen and cause malperfusion.
Pressurization of the false lumen ultimately leads to negative aortic remodeling.
Over time, pressure in the false lumen causes gradual aortic growth, known as negative aortic remodeling. In many cases, negative aortic remodeling leads to rupture or requires reintervention.
Up to 75% of patients experience negative aortic remodeling after hemiarch reconstruction for a type A dissection, and up to 50% require reintervention for complications caused by a persistent dissection after surgical intervention.
Negative Aortic Remodeling
The aorta, which is the artery that delivers oxygenated blood from the heart to the body, consists of three layers. A dissection occurs when the inner layer of the aorta tears, and blood is able to flow between the layers.
This creates a false lumen, or an alternate channel where blood is not supposed to flow. When the aorta is split into two layers, the artery is significantly weakened and can rupture if not treated immediately. Over 70% of aortic dissections happen in the ascending aorta just above the heart, classified as Stanford type A.