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Distal Anastomotic New Entries After Acute Type A Aortic Dissection Surgery: A Retrospective Cohort Study

Year: 2026

Type: article

Abstract: OBJECTIVE: 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. DESIGN: All consecutive patients undergoing type A aortic dissection repair with residual downstream dissection (DeBakey I) between 2011 and 2024 were retrospectively analyzed. Computed tomography angiography was systematically reviewed for DANE using 2-plane distal anastomosis alignment. Longitudinal descending thoracic aortic maximum diameters were analyzed using linear mixed-effects models. Univariable logistic regression, Kaplan-Meier estimates, and Cox proportional hazards analyses were performed. RESULTS: 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 vs 37.3, P = .77). At 3-5 years, estimated maximum descending thoracic aortic diameter was 51.6 vs 42.7 mm, respectively (P < .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 < .001). Overall survival did not differ between groups (hazard ratio 2.04 [0.80-5.18], P = .13). Cox regression demonstrated higher hazard ratios with DANE for reintervention (2.01 [1.01-3.97], P = .04) and reaching ≥55 mm aortic diameter (5.59 [2.33-13.42], P < .001). CONCLUSIONS AND RELEVANCE: 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.

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivag262