Fate of proximal anastomosis after aortic repair for acute aortic dissection

BACKGROUND: This study aimed to investigate events related to proximal anastomosis after acute aortic dissection surgery. METHODS: We analyzed the data of 119 consecutive patients with Stanford type A aortic dissection who underwent emergency surgery at our hospital between October 2015 and March 2023. All patients underwent proximal anastomosis with felt strips and biologic glue reinforcement. Among these, 18 patients (15%) experienced events related to the proximal anastomosis: 14 (12%) had residual dissection in the aortic root, and 4 (3%) had pseudoaneurysms in the aortic root after surgery. We compared the clinical course between the 18 patients with proximal anastomotic events and the other 101 patients. The primary endpoint was all-cause mortality, and the secondary endpoint was redo open-heart surgery. RESULTS: No significant differences were observed in preoperative and procedural characteristics. The incidence of redo open-heart surgery showed a significant difference between the two patient groups (p = 0.0015); however, all-cause mortality showed no significant difference (p = 0.51). The clinical course was different between patients with residual aortic root dissections and those with proximal anastomotic pseudoaneurysms. Residual aortic root dissections were detected via postoperative computed tomography within 1 month and followed-up conservatively owing to the absence of worsening signs. All proximal anastomotic pseudoaneurysms were detected suddenly in the late postoperative phase and presented prompt worsening. All such cases underwent successful redo surgery with patch repair. At reopening, the anastomosis appeared completely detached and nearly ruptured in all cases. CONCLUSIONS: Patients with proximal anastomotic events required redo open-heart surgery significantly more frequently. Patients with residual aortic root dissections and those with proximal anastomotic pseudoaneurysms showed a different clinical course. Residual aortic root dissection was associated with insufficient proximal anastomotic repair because it manifested just after surgery. In contrast, proximal anastomotic pseudoaneurysm occurs suddenly in the late phase and shows prompt worsening, thereby requiring acute repair.