First Reported Use of the AMDS Hybrid Prosthesis for Secondary Type A Aortic Dissection After Prior TEVAR

Type A aortic dissection represents one of the most life-threatening cardiovascular emergencies, with management strategies evolving toward hybrid and endovascular approaches, particularly in high-risk patients. The Ascyrus Medical Dissection Stent (AMDS) is an emerging adjunctive technology designed to promote true lumen expansion and facilitate favorable aortic remodeling during open repair of acute Type A dissection. We present the first reported case of AMDS deployment in secondary Type A dissection following prior thoracic endovascular aortic repair (TEVAR). An 83-year-old female with extensive aortic history-including TEVAR in 2012 for intramural hematoma with chimney stenting to the left subclavian artery and carotid-subclavian bypass in 2013-developed acute Type A dissection extending into the existing stent graft in 2024. Emergency surgical intervention included ascending aortic replacement, aortic arch repair with AMDS implantation, aortic valve resuspension, and left atrial appendage resection under cardiopulmonary bypass and hypothermic circulatory arrest. Postoperative imaging confirmed appropriate AMDS positioning, false lumen exclusion, and preservation of prior endograft integrity. The patient tolerated the procedure well and was discharged in stable condition with favorable early follow-up outcomes. This case demonstrates the potential role of hybrid surgical strategies and adjunctive endovascular devices in managing complex, multi-stage aortic disease.