Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperation

Objective

To identify predictive factors for the occurrence of a distal anastomosis new entry tear (DANE) in patients who underwent hemiarch replacement after acute type A aortic dissection (ATAAD) and examine the association of DANE with distal aortic reoperation.

Methods

Between 1996 and March 2021, 434 patients underwent hemiarch replacement for DeBakey I ATAAD, of whom 327 patients had adequate postoperative imaging. Based on the presence of DANE on postoperative computed tomography angiography, patients were divided into the DANE group (n = 81) and the no-DANE group (n = 246). Primary outcomes were the cumulative incidence of distal aortic reoperation and the risk factors for DANE.

Results

Most perioperative characteristics and outcomes, including age, sex, malperfusion syndromes, aortic diameters, and operative mortality were similar in the 2 groups. Using death as a competing factor, the 10-year cumulative incidence of distal aortic reoperation was higher in the DANE group compared to the no-DANE group (30% vs 12%; P = .0001). The hazard ratio for DANE in distal reoperations was 2.28 (P = .005). A multivariable regression model showed that having an aortic surgeon was protective against DANE compared to having a nonaortic surgeon (odds ratio [OR], 0.29; P = .05) and identified branch dissection (OR, 2.42; P = .002) as a risk factor for the occurrence of DANE. Connective tissue disease and large-bore suture (4-0 vs 5-0) were not associated with DANE.

Conclusions

Optimizing surgical techniques to prevent DANE in ATAAD repair may prevent the need for reoperation on the distal aorta in DeBakey type I ATAAD.