Distal Anastomotic New Entries After Type A Aortic Dissection Repair: An Underreported and Underappreciated Risk?

Background: Acute Stanford type A aortic dissection necessitates emergency surgery. Despite proximal repair, dilation of the downstream aorta is often observed. Distal anastomotic new entry (DANE) may drive adverse remodeling and reintervention. We evaluated the incidence, recognition, and impact of DANE after hemiarch and zone 2 arch replacement. Methods: We retrospectively analyzed 42 patients with residual dissection after type A dissection surgery between January 2022 and 2024. Twenty-three underwent hemiarch and 22 zone 2 arch replacement. All had preoperative computed tomography and up to 1-year follow-up (or until reintervention) of the descending thoracic aorta. DANE was defined as contrast opacification of the false lumen contiguous with the prosthetic lumen. Outcomes included distal aortic growth (≥5 or ≥10 mm/y), maximum diameter ≥50 mm, and reintervention within 6 and 12 months. Results: DANE was identified in 19 of 42 patients (45%), with similar incidence after hemiarch (45%) and zone 2 (46%) replacement. None were reported in radiology assessments; the multidisciplinary aortic team documented 3 (16%). At 1 year, patients with DANE had larger distal aortic maximum diameters (49.2 vs 40.6 mm; Conclusions: DANE occurred frequently after acute dissection repair and was underreported. Its presence was associated with early distal aortic growth and reinterventions. Systematic imaging review and preventive measures against DANE may improve long-term outcomes.