Relationship Between the Primary Entry Tear Locations and Surgical Outcomes of Acute Type A Aortic Dissection: A...

The primary entry tear location affects the prognosis and treatment strategies in aortic dissection. This study aimed to investigate the relationship between entry tear location and surgical outcomes in patients with acute type A aortic dissection (TAAD).

We retrospectively reviewed 89 patients with acute TAAD who underwent surgery between January 2021 and December 2022 at a single center in Vietnam. Patients were categorized into three groups according to entry tear location: ascending aorta, arch, and descending aorta.

Primary entry tears were located in the ascending aorta in 43.8% of patients, the arch in 29.2%, and the descending aorta in 26.9%. False lumen thrombosis occurred most frequently in the descending aorta group. The location of the entry tear influenced the surgical technique; most patients with entry tears at the arch underwent hemiarch or total arch replacement. The overall early mortality and reoperation rates were 11.2% and 5.6%, respectively. Early mortality tended to be higher in the arch group (19.2%) compared with the ascending (12.8%) and descending (0%) aorta groups (P=0.080). The most common cause of reoperation was bleeding, which was more common in the ascending aorta group (P=0.070).

The ascending aorta was the most frequent site of primary entry tear in acute TAAD. Although the differences in early outcomes did not reach statistical significance, the observed trends, including higher early mortality in the arch group and more frequent postoperative bleeding in the ascending aorta group, may reflect the influence of tear location. These findings should be further investigated in larger, multicenter studies.