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

OBJECTIVES: 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. METHODS: 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. 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 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). CONCLUSIONS: 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.