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The authors describe their experience with the Djumbodis system, reporting the findings of a comparative study focussing on the outcomes of surgical management of patients presenting with real type I aortic dissection. The most common feature observed in patients receiving a 9 or 14 cm stent into the proximal descending aorta was stabilization of the dissected thoracic segments. Clinical outcomes were, however, comparable between the groups of stented patients and controls. This clinical result is to be shared with other endovascular devices used in acute dissections and which might require a hybrid operating room, since they might compromise blood flow in collateral arteries. Carefully analysing our data and current literature we propose to consider real type I aortic dissections complicated by dynamic malperfusion symptoms or for which the diameter of the proximal descending aorta is already noticeably dilated as justified indications according to the current knowledge about stenting of acute dissections.

Purpose: In order to remodel or to stabilize the dissected descending aorta following conventional replacement of proximal aorta for real type I acute dissection, the deployment of a bare-metal stent that expand the true lumen and compress the false lumen has been proposed. To date results have been insufficiently assessed through comparative studies. We conducted this study to compare midterm results according to the optional deployment of an antegradely inserted balloon inflated stainless steel stent at the level of the proximal descending aorta during conventional aortic surgery in real type I aortic dissections., Methods: Control study including a consecutive series of patients operated on conventionally for real type I aortic dissection involving descending aorta between 2006 and 2011. For stented patients, an optimal inflation volume was determined a priori according to the measured diameter of landing zone and a bare stent 90 or 140mm long was deployed antegradely during circulatory arrest. Endpoints were mid-term aortic event free survival and the evolution of the indexed (body surface area) diameter of descending aorta., Results: We included 19 and 26 patients in the stented and control group respectively. Aortic event free survival at 4 years was 57% and 43% (p=0.37) in the stented and control group respectively. The proximal descending aorta remained remodeled or stabilized during follow-up for 11 stented and only 9 control patients (p=0.05). After a mean follow up of 2 years, the mean indexed diameter of the upper third aorta was 4 mm wider in the control group due to false lumen enlargement (p=0.01)., Conclusion: Anatomic evolution is favorable in the stented group. Increment of comparative followup data is mandatory before considering a revision of conventional approach of TAAD to influence mid- term aortic event free survival.