Distal anastomotic new entries after acute type A aortic dissection surgery: a retrospective cohort study

Distal anastomotic new entry (DANE) after acute type A aortic dissection repair may contribute to adverse downstream aortic remodelling. This study evaluated the incidence of postoperative DANE and its association with distal aortic growth, reintervention, and clinical outcomes.

All consecutive patients undergoing type A aortic dissection repair with residual downstream dissection (DeBakey I) between 2011 and 2024 were retrospectively analysed. Computed tomography angiography was systematically reviewed for DANE using two-plane distal anastomosis alignment. Longitudinal descending thoracic aortic maximum diameters were analysed using linear mixed-effects models. Univariable logistic regression, Kaplan-Meier estimates, and Cox proportional hazards analyses were performed.

A total of 164 patients were included, of whom 77 (47.0%) had postoperative DANE. Patients with DANE demonstrated larger distal aortic diameters over time compared with patients without DANE, while baseline diameters were similar (37.6 versus 37.3, p = 0.77). At 3-5 years, estimated maximum descending thoracic aortic diameter was 51.6 mm versus 42.7 mm, respectively (p < 0.001). DANE was associated with ≥10 mm downstream aortic growth, ≥55 mm maximum diameter and reintervention during 5-year follow-up (combined odds ratio 5.60 [2.48-12.65], p < 0.001). Overall survival did not differ between groups (hazard ratio 2.04 [0.80-5.18], p = 0.13). Cox regression demonstrated higher hazard ratios with DANE for reintervention (2.01 [1.01-3.97], p = 0.04) and reaching ≥55 mm aortic diameter (5.59 [2.33-13.42], p < 0.001).

DANE occurred frequently after type A aortic dissection repair and was strongly associated with accelerated downstream aortic growth and reintervention. Routine postoperative assessment and strategies aimed at preventing or treating DANE may improve long-term aortic outcomes.