Objectives: Patients undergoing hemiarch repair for acute DeBakey type I dissection (ADTI) are high risk for postoperative stroke, especially if cerebral malperfusion is present preoperatively. We sought to evaluate whether the AMDS Hybrid Prosthesis (AMDS), a bare metal stent designed to promote positive aortic remodelling and prevent distal anastomotic new entry tears, may improve neurological outcomes of patients with ADTI presenting with cerebral malperfusion.
Methods: PERSEVERE enrolled patients presenting with ADTI and malperfusion at 26 sites in North America. Among 93 enrolled patients, 30 (32.3%) presented with cerebral malperfusion. We evaluated for resolution of clinical and/or radiological cerebral malperfusion after hemiarch repair with AMDS.
Results: Cerebral malperfusion was diagnosed clinically in 19 (63.3%) patients and radiographically in 23 (76.7%) patients. Among the patients with clinical cerebral malperfusion, 18 survived the perioperative period; of these 11 (61%) experienced complete resolution of preoperative symptoms, 5 (28%) had no worsening of preoperative symptoms, and 2 (11%) had a new disabling stroke postoperatively. At follow-up, the mean true lumen to total arterial diameter ratio (measured by computed tomography angiography) improved from 30.9% to 64.4% (p = 0.002) in the innominate artery and 33.8% to 60.6% (p = 0.005) in the left common carotid artery from preoperative baseline in patients with radiographic cerebral malperfusion.
Conclusions: Among patients presenting with ADTI and cerebral malperfusion, the majority had resolution or stability of neurological symptoms after hemiarch repair using the AMDS. Radiographic indicators of malperfusion also improved.
Keywords: acute DeBakey type I aortic dissection; cerebral malperfusion; false lumen thrombosis; hemiarch repair; hybrid aortic prosthesis.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.