Surveillance after thoracic aortic surgery yields to low number of reinterventions: A Retrospective Cohort Study

Abstract Aim Postoperative imaging surveillance after thoracic aortic surgery is widely recommended, but its clinical yield, efficiency, and optimal targeting remain poorly defined. We aimed to quantify imaging intensity, determine the procedural yield of surveillance imaging, and assess whether follow-up strategies could be better individualized. Methods We conducted a retrospective single-centre cohort study of patients undergoing thoracic aortic surgery between 2010 and 2024. Postoperative imaging examinations were reviewed and linked with subsequent treatment decisions. Imaging findings, reinterventions, timing of events, detection context, and follow-up patterns were analysed. Results The cohort included 380 patients with 1,757 postoperative imaging examinations, of which 1,074 were classified as surveillance aortic imaging performed ≥30 days after surgery. Overall, 42 examinations led to reintervention in 29 patients (7.6%), including 13 examinations leading to aortic reoperation in 12 patients. Among surveillance aortic examinations, 41 (3.8%) led to reintervention and 16 (1.5%) met treatment thresholds without immediate intervention, yielding a combined directly or potentially actionable finding rate of 5.3%. This corresponded to 26.2 surveillance examinations per reintervention and 82.6 per aortic reoperation. Cumulative incidences of first reintervention were 2.8% at 1 year, 5.9% at 3 years, and 8.3% at 5 years. Most reinterventions were identified during elective surveillance imaging (71.4%). Despite more frequent imaging among emergency patients, reintervention risk and imaging yield were similar to those of non-emergency patients. Conclusion Postoperative imaging surveillance after thoracic aortic surgery was associated with substantial imaging burden but low immediate procedural yield, with clinically relevant findings concentrated in a minority of patients. These findings support the need to better define patient-specific risk and imaging efficiency, but do not establish that less intensive surveillance would be safe without prospective validation.