Distal Anastomotic New Entry Tears Predict Long-Term Outcomes After Hemi-Arch Repair for DeBakey I Aortic Dissection

Aortic arch tears at the time of acute type A dissection are often grouped together and are known to contribute to flow into the residual false lumen, which can increase the risk of delayed complications. This article is the first to investigate the different types of tears, namely residual arch tears (RATs) and distal anastomosis new entry tears (DANEs). It found that DANEs were associated with worse descending aorta modelling and a greater need for reintervention, while RATS were not. An interesting theory suggests that the morphology of tears may contribute to different flow dynamics. For instance, RATs may shunt blood toward the arch vessels and reduce pressure loading of the false lumen, while DANEs may not have an associated pressure relief system. This may have an important effect on technical considerations during the index dissection repair.