Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective
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 2...
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Elsevier
2025-04-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362500066X |
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| author | Rana-Armaghan Ahmad, BS Prabhvir Marway, MD Carlos Alberto Campello Jorge, MD Katelyn Monaghan, BS Divyaam Satija, BS Carol Ling, MS Shinichi Fukuhara, MD Himanshu Patel, MD G. Michael Deeb, MD Nicholas Burris, MD Bo Yang, MD, PhD |
| author_facet | Rana-Armaghan Ahmad, BS Prabhvir Marway, MD Carlos Alberto Campello Jorge, MD Katelyn Monaghan, BS Divyaam Satija, BS Carol Ling, MS Shinichi Fukuhara, MD Himanshu Patel, MD G. Michael Deeb, MD Nicholas Burris, MD Bo Yang, MD, PhD |
| author_sort | Rana-Armaghan Ahmad, BS |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-164e7dfc4bdb4c7fb34dba5b4633b6b9 |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj-art-164e7dfc4bdb4c7fb34dba5b4633b6b92025-08-20T02:25:02ZengElsevierJTCVS Open2666-27362025-04-0124778410.1016/j.xjon.2025.02.016Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspectiveRana-Armaghan Ahmad, BS0Prabhvir Marway, MD1Carlos Alberto Campello Jorge, MD2Katelyn Monaghan, BS3Divyaam Satija, BS4Carol Ling, MS5Shinichi Fukuhara, MD6Himanshu Patel, MD7G. Michael Deeb, MD8Nicholas Burris, MD9Bo Yang, MD, PhD10Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Radiology, Michigan Medicine, Ann Arbor, MichDepartment of Radiology, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Radiology, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich; Address for reprints: Bo Yang, MD, PhD, Department of Cardiac Surgery, Michigan Medicine, 1500 E Medical Center Dr, 5155 Frankel Cardiovascular Center, Ann Arbor, MI 48109.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.http://www.sciencedirect.com/science/article/pii/S266627362500066Xacute type A aortic dissectioncardiothoracic imagingcomputed tomographyDANE |
| spellingShingle | Rana-Armaghan Ahmad, BS Prabhvir Marway, MD Carlos Alberto Campello Jorge, MD Katelyn Monaghan, BS Divyaam Satija, BS Carol Ling, MS Shinichi Fukuhara, MD Himanshu Patel, MD G. Michael Deeb, MD Nicholas Burris, MD Bo Yang, MD, PhD Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective JTCVS Open acute type A aortic dissection cardiothoracic imaging computed tomography DANE |
| title | Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective |
| title_full | Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective |
| title_fullStr | Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective |
| title_full_unstemmed | Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective |
| title_short | Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperationCentral MessagePerspective |
| title_sort | distal anastomosis new entry tear in acute type a aortic dissection a risk factor for distal aortic reoperationcentral messageperspective |
| topic | acute type A aortic dissection cardiothoracic imaging computed tomography DANE |
| url | http://www.sciencedirect.com/science/article/pii/S266627362500066X |
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