Impact of Intimal Tear Location on Clinical Outcomes in Extensive Arch Repair of Acute Stanford Type A Aortic Dissection

Background The impact of intimal tear location on outcomes in acute Stanford type A aortic dissection remains unclear. This study investigated the impact of different tear locations on early and long‐term death in patients undergoing total arch replacement with frozen elephant trunk. Methods This single‐center retrospective study included 1524 patients with acute Stanford type A aortic dissection who underwent total arch replacement with frozen elephant trunk from January 2010 to December 2022. Patients were stratified by primary entry tear location: ascending aorta (n=857 [56.2%]), aortic arch (n=459 [30.1%]), and descending aorta (n=208 [13.6%]). Primary end points were in‐hospital death and long‐term survival. Multivariable regression analyses with further sensitivity analyses for early and long‐term outcomes were performed. Results In‐hospital death differed significantly among groups ( P =0.035): descending tear (21 [10.1%]) versus ascending (46 [5.4%]) versus arch (24 [5.2%]). Multivariable analysis identified descending tear as an independent predictor of in‐hospital death (odds ratio, 3.728 [95% CI, 1.934–7.188]; P <0.001). During a median follow‐up period of 48.2 months, descending tear location remained independently associated with increased long‐term mortality risk (hazard ratio [HR], 2.140 [95% CI, 1.418–3.230]; P <0.001), while arch tears showed no significant difference from ascending tears (HR, 1.232; P =0.227). Reintervention rates did not differ among groups after multivariable adjustment. Conclusions Intimal tear location significantly impacts acute Stanford type A aortic dissection prognosis. Descending aortic tears confer substantially higher early and long‐term mortality rates, requiring aggressive perioperative management and closer surveillance. Tear location should be incorporated into risk stratification systems for individualized treatment planning.