Visceral Entry Tears and Aortic Growth of the Downstream Aorta After Surgery for Acute Type A Aortic Dissection: A Propensity Score Matched Study

All articles of this category (opens in new window) Background: Close follow-up after repair of acute Type A aortic dissection is mandatory to identify patients with negative aortic remodeling. This study investigates the impact of entry tears in the visceral branches on aortic growth of the downstream aorta up to 3 years post-type A repair. Methods: From January 2017 to December 2023, all patients who underwent emergent surgery for acute type A aortic dissection and survived at least 1 year were included. Groups were defined by the presence or absence of preoperative visceral branch entry tears (coeliac trunk, superior mesenterial artery, and/or renal arteries). All available CT-scans were assessed for coronal and sagittal total aortic diameters at zones 1, 4, 7, and 9 at four different timepoints (preoperative, postoperative during the first year, 1–3 years, and after 3 years). Groups were matched according to pre- and intraoperative clinical parameters. Finally, aortic diameters as well as the median aortic growth (preoperative to 3 years) in mm were compared between groups. Results: A total of 157 patients (70 with no visceral tears vs. 87 with visceral tears) were included. The matched cohort comprised two balanced groups with 80 patients (40 matched pairs). At 3 years follow-up, total aortic diameters differed significantly between patients without visceral entry tears vs. with visceral entry tears (sagittal and coronal): 31.49 [29.84–35.70] vs. 39.84 [32.31–48.10] ( p = 0.003) and 32.34 [29.18–39.58] vs. 41.11 [32.22–48.29] ( p = 0.01) at zone 4, 27.56 [25.25–31.28] vs. 33.89 [28.05–37.67] ( p = 0.007) and 26.78 [23.18–31.49] vs. 33.26 [29.67–35.88] ( p = 0.002) at zone 7 and 20.58 [18.71–23.97] vs. 27.33 [24.72–29.89] and 21.08 [18.85, 25.07] vs. 27.10 [24.83, 31.02] ( p = 0.001) at zone 9, respectively. Median aortic growth from preoperative to 3 years postoperative (sagittal and coronal) were 1.64 [−1.27–6.72] vs. 5.55 [2.28–12.81] ( p = 0.056) and 1.55 [−2.66–6.05] vs. 6.95 [1.45–13.60] ( p = 0.002) at zone 4, 1.89 [−0.72–4.36] vs. 5.82 [2.44–8.19] ( p = 0.004) and 3.37 [0.16–6.34] vs. 6.23 [2.83–9.49] ( p = 0.040) at zone 7 and 1.08 [−0.69–3.13] vs. 4.28 [2.07–6.91] ( p = 0.015) and 0.96 [−0.01–4.35] vs. 3.70 [2.25–6.39] ( p = 0.012) at zone 9, respectively. Conclusion: The presence of visceral branch entry tears may be associated with progressive aortic growth at zones 4, 7, and 9 after type A repair. Consistent follow-up of survivors seems of utmost importance to identify patients at risk requiring further treatment of these aortic segments. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany