Clinical and Radiological Outcomes of Acute Type A Aortic Dissection Repair with the Ascyrus Medical Dissection Stent

<b>Objective:</b> This study aimed to evaluate clinical and radiological outcomes of Ascyrus Medical Dissection Stent (AMDS^®, Artivion Inc.) for acute type A aortic dissection (ATAAD). <b>Methods:</b> Between January 2021 and January 2025, all consecutive patients undergoing emergent surgery for ATAAD and hybrid aortic arch repair using the AMDS from two centers were retrospectively analyzed. Demographic, intraoperative, and postoperative data were collected. Patients were stratified based on 30-day or in-hospital mortality. Survival analysis was performed for patients who survived hospital discharge. Radiological evaluation focused on the presence of distal anastomotic new entries (DANEs), false lumen thrombosis, and aortic remodeling on follow-up computed tomography angiography. A total of 46 patients (12 female, mean age 66.1 ± 13.8 years) were included in the study. <b>Results:</b> The 30-day or in-hospital mortality rate was 21.7% (10 patients). There were no significant differences in demographic variables between survivors and non-survivors. All patients underwent hemiarch replacement with AMDS stent placement, with 54.3% also requiring aortic root replacement. Median cross-clamp time, hypothermic circulatory arrest (HCA) time, and time of antegrade selective cerebral perfusion did not differ significantly between the two groups. However, significant differences were observed in median cardiopulmonary bypass (CPB) time (151 vs. 274 min, <i>p</i> = 0.02) and HCA temperature (27 °C vs. 25 °C, <i>p</i> = 0.021). Postoperatively, the non-survivor group showed a significantly higher incidence of dialysis requirement (7.7% vs. 60.0%, <i>p</i> = 0.02), use of mechanical circulatory support (3.9% vs. 44.4%, <i>p</i> = 0.01), and re-exploration for bleeding (15.4% vs. 66.7%, <i>p</i> = 0.023). <b>Conclusions:</b> The AMDS^® is an effective adjunct in hemiarch replacement for ATAAD. Moderate hypothermia and optimized perfusion were linked to better early survival, while the device reliably promoted true-lumen expansion with few DANEs. Its rapid deployment may further facilitate the use of moderate hypothermia by balancing procedural efficiency with systemic protection.