PERSEVERE- a Trial to Evaluate AMDS in Acute DeBakey Type I Dissection

Prospective, non-randomized, multicenter clinical investigation to assess the safety and effectiveness of AMDS in the treatment of patients with acute DeBakey type I dissection, with evidence of malperfusion, through open surgical repair.


Eligibility Criteria:
Inclusion Criteria:

* ≥18 years of age or ≤80 years of age (male or female) at time of surgery
* Acute DeBakey type I dissection based on computed tomography angiography (CTA) and diagnosed ≤14 days from of the index event
* Presence of malperfusion (cerebral, visceral, renal, spinal cord, and/or peripheral)

Exclusion Criteria:

* Other medical condition that is associated with limited life expectancy \<2 years (e.g., cancer, congestive heart failure)
* Pregnant or breastfeeding.
* Unwilling to comply with the follow-up schedule
* Institutionalized due to administrative or judicial order
* Unwilling to accept blood transfusions for any reason
* Coronary malperfusion
* In circulatory shock (i.e., systolic blood pressure \<90 mmHg) at time of screening
* In extreme hemodynamic compromise requiring cardiopulmonary resuscitation at time of screening
* Suspicion of bowel necrosis (as determined by the implanting physician based on imaging observations, peritoneal signs, surgical exploration, elevated serum lactate levels, low pH, and/or acidosis)
* Clinical or radiographic signs of bowel infarction or gastrointestinal hemorrhage
* Base deficit \> -10 mmol/L or -10 mEq/L
* American Society of Anesthesiologists risk class V (i.e., moribund patient not expected to live 24 hours with or without operation) or class VI (a declared brain dead patient whose organs are being removed for donor purposes)
* Previous placement of a thoracic endovascular graft
* Interventional and/or open surgical procedures 30 days prior to the dissection repair
* Planned major interventional and/or open surgical procedures 30 days post the dissection repair
* Systemic infection
* Uncontrollable anaphylaxis to iodinated contrast (patients with allergy to iodinated contrast but not anaphylaxis may be eligible with appropriate pre-medication, as deemed suitable by the Investigator)
* Known allergy(ies) to nitinol and/or polytetrafluoroethylene
* Inability to obtain CT angiograms for follow-up
* Previously diagnosed with Marfan syndrome, Ehlers-Danlos syndrome, or Loeys-Dietz syndrome based on laboratory genetic testing
* Diagnosed with acute myocardial infarction in the 30 days prior to the dissection diagnosis
* Diagnosed with severe and catastrophic neurological complications in the 30 days prior to the dissection diagnosis (namely, obtundation or coma)
* Current Stage 5 end stage chronic kidney disease (eGFR ≤ 15 mL/min)
* History of bleeding disorder (i.e. hemophilia)
* A primary entry tear that extends into the arch or distal to the left subclavian artery
* Need for a total aortic arch replacement and/or repair, or reconstruction, of any part of the arch, and branch vessels (including extra-anatomic bypass of the branch vessels), for any reason as deemed necessary by the Investigator
* Any pathology of mycotic origin
* Aortic fistulous communication with non-vascular structure (e.g., esophagus, bronchial)
* Extensive thrombus or calcifications in the aortic arch, as defined by CTA
* Excessive tortuosity precluding safe passage of the AMDS, as defined by CTA
* Descending thoracic aneurysm involving the proximal third (one-third) of the descending aorta and measuring \>45 mm in diameter
* Aortic arch aneurysm \>50 mm in diameter