Distal anastomotic new entry tears and aortic remodeling following type A dissection repair: A systematic review

Acute type A aortic dissection (ATAAD) is an emergent, life-threatening condition.1 Traditionally, the focus of ATAAD, both clinically and in research settings, has been on the acute and perioperative phases.The significant surgical risk, complex management, and high rates of postoperative morbidity have garnered the bulk of the attention for these patients.Our understanding of the pathophysiology and surgical management of ATAAD have evolved over the preceding decades, with a greater emphasis on longterm outcomes and aortic remodeling.[2][3][4][5][6][7] Approaches for mitigating adverse remodeling have been highlighted in the most recent Society of Thoracic Surgeons and European Association of Cardio-Thoracic Surgery aortic guidelines.8 Poor outcomes related to adverse aortic remodeling have been identified, and factors that impact adverse aortic remodeling have been uncovered.One such factor is distal anastomotic new entry tears (DANE).DANE refers to tears at the distal aortic anastomosis, thought to result from communications at the distal suture line, which create new tears allowing false lumen (FL) perfusion.DANE has been reported in up to 70% of ATAAD cases and is associated with adverse aortic remodeling and outcomes.3,[9][10][11] Commonly identified following ATAAD on appropriate postoperative imaging, numerous approaches have been undertaken in an attempt to prevent DANE and in turn facilitate improved aortic remodeling and outcomes.Here we report a systematic review of the literature focused on the development and prevention of DANE and adverse aortic remodeling following ATAAD repair. METHODS