Objectives The effect of distal anastomotic new entry (DANE) due to suture cutting at the distal anastomosis on the postoperative course remains unknown. We aimed to investigate the impact of DANE on the postoperative course in acute type A aortic dissection (AAAD). Materials and Methods This study included 121 patients with AAAD who underwent emergency surgery at our hospital between August 2015 and March 2023. Of 121 patients, 15 (12%) showed DANE. In total arch replacement cases, no DANE was observed ( p = 0.0002). The primary endpoint was all‐cause mortality, and the secondary endpoint was any major adverse aortic event (MAAE). Results Of the 15 patients who showed DANE, 10 cases were followed up conservatively. However, five cases (33%) developed MAAE, including death due to rupture of the aortic arch in one case. No significant differences were observed between the preoperative factors and postoperative complications, except for retrograde AAAD and peripheral malperfusion. There was no significant difference between the two groups; however, MAAE frequently occurred in patients with DANE ( p = 0.092), and the cause of MAAE tended to be related to DANE in these cases. Conclusions DANE can contribute to the enlargement of the descending aorta and occasionally result in rupture, which can be fatal. Total arch replacement with the frozen elephant trunk technique (TARFET) is expected to reduce the incidence of DANE. Further multicentric studies with larger samples are required to validate these findings.
Sugiyama et al. (Thu,) studied this question.