Proximal Anastomotic New Entry Tear Following Surgical Repair of Acute Type A Aortic Dissection: Anatomical Location, Risk Factors, and Impact on Long-Term Outcomes

OBJECTIVES: Proximal anastomotic new entry tear (PANE) after surgical repair of acute type A aortic dissection (ATAAD) remains poorly characterized. This study aimed to determine the incidence, anatomical distribution, perioperative risk factors, and long-term impact of PANE. METHODS: We retrospectively analysed 532 consecutive patients who underwent open aortic repair for ATAAD at our institution between 2003 and 2023. Patients without postoperative contrast-enhanced computed tomography (CT) or those who underwent root procedures were excluded. PANE was defined as true-false lumen communication or pseudoaneurysm formation at the proximal anastomosis on CT. Risk factors were assessed using multivariable logistic regression. Long-term outcomes were evaluated using Kaplan-Meier and Fine-Gray competing risk analyses. RESULTS: The final study cohort included 425 patients; PANE occurred in 50 (11.8%), predominantly at the noncoronary sinus (70% isolated, 88% including adjacent sinuses) and colocalized with preoperative dissection sites in 96% of cases. Independent risk factors were preoperative severe aortic regurgitation (OR 3.69, 95% CI 1.23-11.1, P = .020) and surgery by less experienced surgeons (OR 3.75, 95% CI 1.53-9.23, P = .004), whereas biological glue use was protective (OR 0.37, 95% CI 0.19-0.70, P = .002). Long-term survival was not significantly different between groups (P = .086). PANE significantly increased proximal reoperation risk (10-year cumulative incidence 14.2% vs 2.2%; subdistribution HR 8.39, 95% CI 3.35-21.0, P < .001). CONCLUSIONS: PANE affected 12% of ATAAD repairs and significantly increased reoperation risk without affecting survival. Prevention may require experienced surgical teams and optimized anastomotic techniques. All patients warrant early postoperative CT imaging to aid identification and guide surveillance strategies. CLINICAL REGISTRATION NUMBER: 4667.