Distal anastomotic new entry tears predict long-term outcomes after hemi-arch repair for DeBakey I aortic dissection†.

OBJECTIVES

Aortic arch tears, including distal anastomosis new entry tears and residual arch tears, have been associated with adverse outcomes (false lumen growth, distal reoperation) after hemi-arch repair for DeBakey Type I aortic dissection. However, no study has compared distal anastomosis new entry tears and RATs as independent entities despite their distinct aetiologies and preventative strategies which may inform surgical management.

METHODS

Retrospective cohort study of adult patients with hemi-arch repair for DeBakey Type I aortic dissection at a tertiary referral centre (1996-2021). We included patients who survived beyond their initial hospitalization with good-quality post-operative CT angiograms. Distal anastomosis new entry tears and residual arch tears metrics were collected from the first good-quality post-operative CT. Maximal aortic diameters (distal to graft) were collected from pre- and post-hemi-arch repair CT angiograms. Presence and imaging characteristics of distal anastomosis new entry tears and RATs were examined for prediction of false lumen growth and distal aortic intervention.

RESULTS

We included 272 patients, and 24.5% (69) had distal anastomosis new entry tears, which on multivariable analysis was associated with a post-operative descending diameter change of +6.2 mm (95% confidence interval [CI]: 4.5, 7.9) and greater risk of distal intervention, hazard ratio 3.24 (95% CI: 1.57, 6.68); residual arch tears were not significantly associated, hazard ratio 0.72 (95% CI: 0.28, 1.83). Distal anastomosis new entry tears located on the greater curvature versus lesser curvature (58% vs 42%, P = 0.044) were more likely to lead to reoperation (45% vs 17%, P = 0.033).

CONCLUSIONS

Distal anastomosis new entry tears, not residual arch tears, correlate strongly with negative descending aorta remodelling and distal intervention after hemi-arch repair for DeBakey I aortic dissection. Therefore, additional strategies are warranted to prevent distal anastomosis new entry tears, a result of anastomotic technical challenge, during operative repair.