Impact of Intimal Tear Location on Clinical Outcomes in Extensive Arch Repair of Acute Stanford Type A Aortic...

The impact of intimal tear location on outcomes in acute Stanford type A aortic dissection remains unclear. This study investigated the impact of different tear locations on early and long-term death in patients undergoing total arch replacement with frozen elephant trunk.

This single-center retrospective study included 1524 patients with acute Stanford type A aortic dissection who underwent total arch replacement with frozen elephant trunk from January 2010 to December 2022. Patients were stratified by primary entry tear location: ascending aorta (n=857 [56.2%]), aortic arch (n=459 [30.1%]), and descending aorta (n=208 [13.6%]). Primary end points were in-hospital death and long-term survival. Multivariable regression analyses with further sensitivity analyses for early and long-term outcomes were performed.

In-hospital death differed significantly among groups (P=0.035): descending tear (21 [10.1%]) versus ascending (46 [5.4%]) versus arch (24 [5.2%]). Multivariable analysis identified descending tear as an independent predictor of in-hospital death (odds ratio, 3.728 [95% CI, 1.934-7.188]; P<0.001). During a median follow-up period of 48.2 months, descending tear location remained independently associated with increased long-term mortality risk (hazard ratio [HR], 2.140 [95% CI, 1.418-3.230]; P<0.001), while arch tears showed no significant difference from ascending tears (HR, 1.232; P=0.227). Reintervention rates did not differ among groups after multivariable adjustment.

Intimal tear location significantly impacts acute Stanford type A aortic dissection prognosis. Descending aortic tears confer substantially higher early and long-term mortality rates, requiring aggressive perioperative management and closer surveillance. Tear location should be incorporated into risk stratification systems for individualized treatment planning.