title: Retrograde Ascending Aortic Dissection After Thoracic Endovascular Aortic Repair for Distal Aortic Dissection or With Zone 0 Landing: Association, Risk Factors, and True Incidence.
abstract: BACKGROUND
  We attempted to determine the true incidence of retrograde ascending aortic dissection (rAAD) and to challenge its reported association with distal aortic dissection or zone 0 deployment.
  
  
  METHODS
  From January 2005 to August 2014, 305 patients who were at risk for rAAD underwent thoracic endovascular aortic repair. We excluded patients with prior ascending, hemiarch, or traditional or frozen elephant trunk grafts, or who required concomitant ascending graft placement. Patients in group A (n = 111, 36.4%) had distal aortic dissection or hematoma (n = 75, 67.6%) or required landing of the endograft in zone 0 of the native ascending aorta (n = 36, 32.4%). Patients in group B (n = 194, 63.6%) had nondissected descending or distal arch aneurysm (n = 172), penetrating ulcer (n = 9), coarctation (n = 6), endoleak not caused by dissection (n = 3), aortobronchial fistula (n = 3), or transection (n = 1).
  
  
  RESULTS
  The incidence of rAAD was 1.3% overall (n = 4), 0.9% in group A (n = 1, Cook Zenith TX2), and 1.5% in group B (n = 3; 1 Talent Captivia, 2 Cook Zenith TX2; p = 0.64). No zone 0-treated patient had rAAD. Two patients from group B died, and 1 was treated nonoperatively. The median interval between thoracic endovascular aortic repair and rAAD was 11 days (range, 0 to 90 days).
  
  
  CONCLUSIONS
  Post-thoracic endovascular aortic repair rAAD is a rare but lethal complication. Operator experience is crucial for prompt recognition and prevention. It does not appear that rAAD is specifically associated with distal aortic dissection or landing in zone 0. To our knowledge, this is one of the few studies to report the true incidence of rAAD in at-risk patients.
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: opsmile01@aol.com.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garcia
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Kristy
authors.initials: K
authors.lastname: Moeller
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors.forename: Denton A
authors.initials: DA
authors.lastname: Cooley
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Lorena
authors.initials: L
authors.lastname: Gonzalez
authors.affiliation: Department of Cardiovascular Radiology, Texas Heart Institute, Houston, Texas; Department of Radiology, Baylor St. Luke's Medical Center, Houston, Texas.
authors.forename: Benjamin Y
authors.initials: BY
authors.lastname: Cheong
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Kalyan
authors.initials: K
authors.lastname: Vunnamadalla
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors