{"doi":"10.1093/ejcts/ezaf170","title":"Distal anastomotic new entry tears predict long-term outcomes after hemi-arch repair for DeBakey I aortic dissection","abstract":"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.","journal":"European Journal of Cardio-Thoracic Surgery","year":2025,"id":528247,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9621,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1406595,"name":"Carlos Alberto Campello","orcid":null,"position":1,"is_corresponding":false},{"id":948746,"name":"Rana‐Armaghan Ahmad","orcid":null,"position":2,"is_corresponding":false},{"id":1249800,"name":"Nicasius Tjahjadi","orcid":"0009-0009-7377-2080","position":3,"is_corresponding":false},{"id":425831,"name":"Himanshu J. Patel","orcid":"0000-0001-7639-2416","position":4,"is_corresponding":false},{"id":262055,"name":"Bo Yang","orcid":"0000-0002-2158-9155","position":5,"is_corresponding":false},{"id":425832,"name":"Nicholas S. Burris","orcid":"0000-0002-5198-4383","position":6,"is_corresponding":false},{"id":1272604,"name":"Prabhvir S Marway","orcid":null,"position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":null,"created_at":"2026-07-19T02:50:48.492873Z","pmid":"40397142","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}