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Comparison of Outcomes in DeBakey Type AI Versus AII Aortic Dissection

Louis P Kohl1, Eric M Isselbacher2, Nilla Majahalme3

  • 1Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, Minnesota; Hennepin County Medical Center, Minneapolis, Minnesota.

The American Journal of Cardiology
|July 5, 2018
PubMed

Insights

Type II acute aortic dissection (AAD), limited to the ascending aorta, shows fewer complications and a trend toward lower mortality than type I AAD. However, long-term outcomes and survival rates remain similar between the two types.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • The DeBakey classification categorizes type A acute aortic dissection (AAD) into type I and type II.
  • Type II AAD is specifically limited to the ascending aorta, distinguishing it from type I, which involves more extensive aortic involvement.

Purpose of the Study:

  • To investigate and compare the clinical characteristics and outcomes of patients with DeBakey type I versus type II acute aortic dissection.
  • To identify differences in presentation, complications, and treatment strategies between these two subtypes of AAD.

Main Methods:

  • Analysis of 1,872 patients with non-iatrogenic AAD from the International Registry of Acute Aortic Dissection.
  • Stratification of patients into DeBakey type I (90.3%) and type II (9.7%) groups.
  • Comparison of demographic data, clinical presentation, intramural hematoma frequency, treatment modalities, and in-hospital outcomes.

Main Results:

  • Patients with type II AAD were older and presented with more intramural hematoma.
  • Type I AAD was associated with more back/abdominal pain and pulse deficits.
  • Type II AAD exhibited lower rates of renal failure, coma, mesenteric/limb ischemia, and a trend toward reduced in-hospital mortality (16.6% vs. 22.5%).

Conclusions:

  • Acute aortic dissection limited to the ascending aorta (DeBakey type II) is associated with improved clinical outcomes compared to dissections extending beyond the ascending aorta.
  • Despite fewer immediate complications and a trend towards lower in-hospital mortality in type II AAD, long-term outcomes including 5-year survival and descending aortic sequelae are not significantly different.

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