Operated acute DeBakey type I aortic dissection has to be considered as a chronic aortic disease with the potential of late distal dilatation with aneurysm formation and need for reoperation. Several intraoperative strategies have been devised to prevent late complications. However, the increased operative risk associated with a more aggressive initial approach in an emergent setting has to be balanced against the relatively low incidence of late reoperations. Further studies will have to identify preoperative risk factors for late distal aortic complications more precisely in order to select patients who might benefit the most from these newer surgical strategies.