Fate of proximal anastomosis after aortic repair for acute aortic dissection

Objective: We tried to investigate events related to the proximal anastomosis after acute aortic dissection surgery. Methods: Between October 2015 and March 2023, we studied 119 consecutive patients with Stanford type A aortic dissection who underwent emergency surgery at our hospital. 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. The primary endpoint was all-cause mortality, and the secondary endpoint is redo open-heart surgery. Results: No significant differences were observed in preoperative and procedural characteristics. Redo open-heart surgery showed significant difference (p = 0.0015); however, all-cause mortality showed no significant difference (p = 0.51). The clinical course between residual aortic root dissections and proximal anastomotic pseudoaneurysms was different. Residual aortic root dissections were detected via postoperative computed tomography within one month and followed up conservatively because these showed no worsening. All proximal anastomotic pseudoaneurysms, detected suddenly in late postoperative phase and presented prompt worsening, underwent successful redo surgery with patch repair. At reopening, the anastomosis appeared completely detached and nearly ruptured in all cases. Conclusions: The clinical course between residual aortic root dissections and proximal anastomotic pseudoaneurysms was different. Residual aortic root dissections seemed associated to insufficient proximal anastomotic repair because it revealed just after surgery. In contrast, proximal anastomotic pseudoaneurysms occur suddenly in the late phase and showed prompt worsening requiring acute repair.