For older patients with acute type A aortic dissection, extensive arch reconstruction surgery is not necessarily better than a simpler approach, according to nationwide data. Surgical repair of type A aortic dissection in elderly patients carries a higher risk of short-term mortality, but remains the treatment of first choice. The main postoperative results are comparable with younger patients and the medium-term survival is acceptable[1]. Without surgery, approximately 75% of patients die within two weeks of the onset of symptoms[1]. In elderly patients, a less aggressive surgical approach such as supracoronary aortic replacement is preferred because it is safer and more effective than complex operations[1]. This approach reduces operative time and mortality, with an emphasis on the prevention of aortic rupture[1]. Registry data show a higher proportion of simpler procedures in older compared to younger patients[1].