Die AMDS-Hybridprothese – ein neues Device zur Behandlung der akuten Typ-A-Dissektion

The DeBakey type I aortic dissection is a life-threatening cardiac surgical emergency. According to current guidelines, hemiarch replacement with an open distal anastomosis under moderate hypothermia and selective antegrade cerebral perfusion is recommended; however, residual dissection, malperfusion and negative aortic remodelling remain potential problems. To address these issues, the Ascyrus Medical Dissection Stent (AMDS, Artivion®, Atlanta, GA, USA) has been developed as an adjunct to hemiarch replacement.

To provide an overview of the AMDS, its indications for use, current study results and potential challenges.

Evaluation of the available literature and clinical outcomes related to AMDS implantation in DeBakey type I aortic dissection.

Additional AMDS implantation in terms of hemiarch replacement in zone 0 is safe, uncomplicated and extends the procedural time by only a few minutes. Initial study results show satisfactory results of additional AMDS implantation with comparable perioperative mortality and morbidity, while the rate of distal anastomotic new entry (DANE) is significantly lower. Additionally, false lumen thrombosis is significantly improved after AMDS implantation. Available data also hint towards a positive effect on the treatment of dissection-associated malperfusion.

The AMDS represents a promising upgrade to isolated hemiarch replacement in DeBakey type I dissection; however, it should be considered that not all patients are suitable candidates for the AMDS. Long-term data and detailed analyses comparing it to isolated hemiarch replacement are urgently needed to confirm its benefits.