Distal Anastomotic New Entries After Acute Type A Aortic Dissection Surgery: A Retrospective Cohort Study
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.
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BibTeX
@article{dinter2026distal,
title = {{Distal Anastomotic New Entries After Acute Type A Aortic Dissection Surgery: A Retrospective Cohort Study}},
author = {Stefan R van Dinter and Pim S van Sambeeck and Nesar A Hasami and Amir H Sadeghi and Michel W A Verkroost and Tychon E A Geeraedts and Jan Jaap Janssen and Foeke J H Nauta and Nabil Saouti and Robin H Heijmen},
journal = {Interdisciplinary Cardiovascular and Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/icvts/ivag262},
url = {https://doi.org/10.1093/icvts/ivag262},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Distal Anastomotic New Entries After Acute Type A Aortic Dissection Surgery: A Retrospective Cohort Study
AU - Stefan R van Dinter
AU - Pim S van Sambeeck
AU - Nesar A Hasami
AU - Amir H Sadeghi
AU - Michel W A Verkroost
AU - Tychon E A Geeraedts
AU - Jan Jaap Janssen
AU - Foeke J H Nauta
AU - Nabil Saouti
AU - Robin H Heijmen
PY - 2026
DA - 2026/09/25
JO - Interdisciplinary Cardiovascular and Thoracic Surgery
DO - 10.1093/icvts/ivag262
UR - https://doi.org/10.1093/icvts/ivag262
AB - 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.
SN - 2753-670X
ER -