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Diagnosis and Treatment of Aortic Dissection: Experts' Views

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 25 July 2026 | Viewed by 2282

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Special Issue Editors

Prof. Dr. Marja K Hedman

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Guest Editor

1. Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, 80101 Kuopio, Finland
2. Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, 70029 Kuopio, Finland
Interests: aortic diseases; cardiovascular diseases; cardiovascular imaging; 4D flow MRI; gene therapy

Dr. Annastiina Husso

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Guest Editor

Department of Cardiothoracic Surgery, Kuopio University Hospital, 70029 Kuopio, Finland
Interests: aortic diseases; aortic surgery; aortic dissection

Special Issue Information

Dear Colleagues,

Acute type A aortic dissection continues to pose a major clinical challenge due to its sudden and unpredictable nature. Although recent advances have led to the identification of new risk markers, a substantial proportion of patients do not meet the current thresholds for preventive surgery at the time of dissection onset. This underscores the ongoing need to investigate additional mechanisms and risk factors underlying this devastating condition, in order to improve the management and outcomes of aortic dilatation.

Advances in understanding the factors influencing ascending aortic dilatation have enhanced our ability to identify high-risk individuals. Recent discoveries in cellular and molecular changes within the aortic wall, along with insights into altered aortic flow dynamics, have begun to illuminate functional processes that contribute to aortic dilatation and dissection.

In this Special Issue, we aim to present the latest research on the flow dynamics, growth patterns, and risk prediction of acute type A aortic dissection. Through the integration of cutting-edge knowledge and multidisciplinary collaboration, we can make significant strides in addressing this critical clinical problem.

Prof. Dr. Marja K Hedman
Dr. Annastiina Husso
Guest Editors

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Keywords

aortic diseases
aortic type A dissection
aortic growth rate
aortic length
aortic imaging

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Research

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8 pages, 295 KB

Open AccessArticle

Urgent and Emergent Endovascular Treatment of the Downstream Aorta Soon After Open Surgical Repair in Acute Type A Aortic Dissection: Analyzing Indications and Outcomes of an Institutional Case Series

by Peter Donndorf, Theresa Angles, Clemens Schafmayer and Justus Groß

J. Clin. Med. 2026, 15(3), 936; https://doi.org/10.3390/jcm15030936 - 23 Jan 2026

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Abstract

Objectives: Thoracic endovascular aortic repair (TEVAR) is rarely indicated on an urgent or emergent basis soon after open surgical repair of type A aortic dissection (TAAD), and systematic data on clinical outcomes are therefore missing. In the present study, we analyze a contemporary case series regarding the outcome after urgent and emergent endovascular treatment of the downstream thoracic aorta, following open surgery for TAAD. Methods: The study was conducted as a retrospective observational analysis. From January 2024 until April 2025, seven patients (four male, aged 56.8 ± 5.6 years) were treated with TEVAR on an urgent or emergent basis within 48 h after open surgical repair of TAAD at our institution. In all seven patients, the initial dissection extended from the ascending to the abdominal aorta. All seven patients had previously received emergent open surgical repair by ascending aortic repair combined with hemiarch replacement (five patients) or total arch replacement, utilizing the frozen elephant trunk (FET) technique (two patients). Results: In four patients, the indication for urgent TEVAR was due to true lumen collapse (TLC) of the downstream aorta with resulting visceral or peripheral malperfusion symptoms. Three patients were treated on an emergent basis, due to rupture of the descending thoracic aorta with a resulting hemorrhage. Technical success of the TEVAR procedure was 100%. Thirty-day mortality was 0% in the TLC cases but 66% in the ruptured cases, where two of three patients died postoperatively due to the consequences of severe hemorrhagic shock. Within the surviving patients, no subsequent aortic events occurred during follow-up. Late mortality was 0%. The follow-up period was 15.7 ± 2.0 months. Conclusions: In our case series, mortality of urgent or emergent TEVAR soon after open surgical repair for TAAD is substantial, especially in patients that were treated due to acute rupture of the descending thoracic aorta and consecutive hemorrhagic shock. On the other hand, true lumen collapse with resulting malperfusion was successfully treated by instant TEVAR application in all patients without late aortic complications by the midterm follow-up. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Aortic Dissection: Experts' Views)

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11 pages, 1016 KB

Open AccessArticle

Diabetes Mellitus Is Associated with Distinctive Aortic Wall Degeneration During Acute Type A Aortic Dissection

by Santtu Heikurinen, Ivana Kholova, Timo Paavonen and Ari Mennander

J. Clin. Med. 2025, 14(13), 4731; https://doi.org/10.3390/jcm14134731 - 4 Jul 2025

Cited by 2 | Viewed by 972

Abstract

Background: Non-adjustable patient characteristics such as diabetes mellitus may influence surgical decision-making and outcome after acute type A aortic dissection (ATAAD). The aim of this study was to compare the degree of aortic wall atherosclerosis and surgical solutions in patients with diabetes mellitus versus those without during ATAAD. Methods: Altogether, 123 consecutive patients undergoing surgery for ATAAD at Tampere University Heart Hospital were evaluated. The ascending aortic wall resected in surgery was processed for histopathological analysis of atherosclerosis, inflammation, and medial layer degeneration. Patients with and without diabetes mellitus were compared during a mean 4.7-year follow-up. Results: There were 11 patients with diabetes mellitus and 112 without. The mean age for all patients was 63.6 years (standard deviation [SD] 13.3). Altogether, 48 patients had a conduit aortic prosthesis replacing the aortic root together with the ascending aorta, including only one patient with diabetes (p = 0.049). Nine patients received a frozen elephant trunk prosthesis to treat the aortic arch together with the ascending aorta. The severity of ascending aorta atherosclerosis was more prominent in patients with diabetes mellitus as compared to patients without (0.8 [0.4] vs. 0.3 [0.5], p = 0.009, respectively). During follow-up, 8 and 78 patients with and without diabetes died, respectively (logarithmic rank p = 0.187). Conclusions: Histopathology of the ascending aorta during ATAAD reveals distinctive severity of aortic wall atherosclerosis in patients with diabetes mellitus versus those without. The degree of atherosclerosis assessed postoperatively is associated with the extent of surgical procedure in many patients and may guide follow-up protocol. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Aortic Dissection: Experts' Views)

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Review

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20 pages, 1721 KB

Open AccessReview

Type A Aortic Dissection: From Diagnosis to Cardiac Rehabilitation

by Monica Loguercio, Maria Grazia Romeo, Buket Akinci, Cristina Andreea Adam, Irfan Ullah, Marta Supervía, Giancarlo Trimarchi, Natalia Świątoniowska-Lonc, Federica Fogacci and Francesco Perone

J. Clin. Med. 2026, 15(7), 2749; https://doi.org/10.3390/jcm15072749 - 5 Apr 2026

Cited by 1 | Viewed by 667

Abstract

Acute type A aortic dissection is a life-threatening condition requiring emergency surgery and complex postoperative management. Although survival rates have improved, many patients experience long-term functional impairments, reduced quality of life, and an elevated risk of complications. Despite strong evidence supporting cardiac rehabilitation in other cardiovascular populations, structured programs remain underutilized in patients with surgically resolved acute type A aortic dissection. Exercise-based cardiac rehabilitation appears feasible and can be delivered safely in carefully selected patients when appropriately adapted to individual needs and conducted under close supervision. Postoperative patients are often physically deconditioned, prone to hospital-acquired disability, and may misjudge exercise intensity. Therefore, individualized exercise prescription, guided by exercise testing when available, is important to support safe training thresholds. Early and gradual introduction of physical activity may help prevent complications associated with immobility, support blood pressure control, and contribute to improvements in functional capacity. However, training volume should be purposefully lower than in conventional program settings to reduce hemodynamic stress. Education on safe exercise parameters and self-monitoring plays a central role in enabling long-term adherence and promoting patient autonomy. Cardiac rehabilitation programs should incorporate dietary, nutritional, and psychological support. Although evidence specific to this patient population remains limited, available data suggest the feasibility and potential benefits of cardiac rehabilitation when delivered with appropriate precautions. Our review underscores the need for a tailored, multidisciplinary CR approach aimed at enhancing physical recovery, supporting cardiovascular stability, and improving overall quality of life in patients following surgery. Further research is required to define optimal program protocols. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Aortic Dissection: Experts' Views)

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