Clinical outcomes of residual branch vessel dissection following type A aortic dissection repair.

Objectives: Although aortic arch replacement eliminates the primary entry tear in type A aortic dissection, residual dissection in arch branch vessels (RD-ABV), often linked to fragile distal tissue or residual tears, may sustain false lumen patency and be related to post-discharge recovery. The clinical relevance of RD-ABV remains unclear. Methods: This retrospective cohort study included patients who underwent total arch replacement for aortic dissection between January 2018 and December 2024. Patients with in-hospital postoperative cerebral infarction, cerebral hemorrhage, or death were excluded, and follow-up began on the date of discharge. RD-ABV was assessed using the first postoperative CTA before discharge. The primary outcome was a composite event including modified Rankin Scale (mRS) 3-6, cerebral infarction (CI), cerebral hemorrhage (CH), and cardiovascular and cerebrovascular reoperation. Secondary outcomes included CI, CH, and reoperation. IPTW-adjusted win ratio was used for analyses of the primary and secondary composite outcomes. Results: A total of 564 patients were included, of whom 156 had RD-ABV. The IPTW-adjusted win ratio of the primary composite outcome was 0.47 (95% CI: 0.27-0.82; Conclusion: Among selected post-discharge survivors after aortic arch replacement, RD-ABV was associated with worse mid-term functional recovery, mainly reflected by mRS 3-6. The secondary composite outcome excluding mRS did not reach statistical significance. These findings should be interpreted as hypothesis-generating and require prospective validation.