Abstract
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.