In-hospital vascular surgery consultation is associated with improved follow-up and earlier identification of aneurysmal degeneration after acute Type A aortic dissection.

OBJECTIVE: Acute Type A aortic dissections (TAAD) are historically managed by cardiac surgery. However, subsequent treatment of residual dissection within the thoracoabdominal aorta often requires vascular surgical intervention and lifelong surveillance. This study assesses long-term outcomes by completeness of follow-up after operative intervention for acute TAAD.

METHODS: Patients who underwent surgical intervention for acute TAAD from 2014 to 2025 were identified. Patients who experienced death within 30-days or those with dissection limited to Zone 0/Zone 1 were excluded. Vascular surgery evaluation and time to consultation (index-hospitalization, outpatient, none) was documented. Follow-up was classified as complete, incomplete, or lost (LTF) according to the frequency of contrasted thoracoabdominal imaging, consistent with clinical practice guidelines. Trends in completeness of follow-up were described. Demographics, anatomic/operative characteristics, and perioperative outcomes were compared between complete follow-up and incomplete follow-up/LTF groups. Long-term outcomes (aortic degeneration, planned secondary intervention, survival) were assessed with Kaplan-Meier and multivariable Cox regression analysis.

RESULTS: 241 patients were included; 80% had vascular surgery consultation (70% inpatient, 30% outpatient) and 86% of consultations occurred within 1-year of index procedure. In total, 46% of patients had complete follow-up, 41% had incomplete follow-up, and 13% were LTF. In-hospital consultation increased by 58% over the study period. Demographics, comorbidities, and anatomic characteristics were similar between groups. Patients with complete follow-up had higher rates of complex arch repair (Zone 1-3) (complete 56% vs. incomplete/LTF 27%, p<0.001), were more likely to undergo genetic testing (complete 52% vs. incomplete/LTF 18%, p<0.001), in-hospital TEVAR extension (7% vs. 2%, p=0.028), and TEVAR extension within 3 months (complete 17% vs. incomplete/LTF 5%, p=0.002). In time-to-event analysis, complete follow-up was associated with more planned secondary interventions (complete: 12% vs. incomplete: 5%, p=0.007) and identified aneurysmal degeneration (32% vs. 15%, p=0.002) within 1-year of acute dissection. Long-term survival differed by completeness of follow-up; 1-year (complete: 97% vs. incomplete: 97% vs. LTF: 91%), 3-years (complete: 92% vs. incomplete: 95% vs. LTF: 81%, p=0.021). There were no aortic-related deaths for patients with complete follow-up and five aortic-related deaths (5%) in patients with incomplete follow-up (p=0.13). In-hospital vascular surgery consultation was associated with complete follow-up (HR 2.87, 95% CI 1.6-5.1) and planned secondary interventions (HR 2.07, 95% CI 1.1-3.9).

CONCLUSION: Vascular surgery consultation is associated with increased identification of aneurysmal degeneration, planned secondary interventions, and mid-term survival. These data suggest that longitudinal vascular surgical care, starting with in-hospital consultation, is a critical component of care following acute TAAD and should be strongly considered to ensure appropriate postoperative surveillance and improve long-term patient outcomes.