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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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A New Aortic Arch Dissection Classification: The Fuwai Classification.

Juntao Qiu1, Xinjin Luo1, Jinlin Wu1

  • 1Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|October 1, 2021
PubMed
Summary

A new Fuwai classification for aortic arch dissection (AcD) categorizes patients into types Cp, Ct, and Cd. While surgical mortality varies by type, long-term outcomes and reoperation rates are similar across all classifications.

Keywords:
aortic arch dissectionclassification systemclinical characteristicmortalitysurgery

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Diseases

Background:

  • Aortic arch dissection (AcD) is a life-threatening condition requiring precise classification for effective treatment.
  • Existing classifications may not fully capture the nuances of AcD, impacting clinical decision-making and prognosis assessment.
  • A novel classification system is needed to better stratify AcD patients and guide surgical strategies.

Purpose of the Study:

  • To introduce and describe the novel Fuwai classification for aortic arch dissection (AcD).
  • To compare the clinical characteristics and long-term prognoses of AcD patients based on the new Fuwai classification.
  • To evaluate the utility of the Fuwai classification in predicting surgical outcomes and guiding treatment approaches.

Main Methods:

  • Retrospective analysis of 1,063 AcD patients undergoing surgery at Fuwai Hospital (2010-2015).
  • Classification of AcD into three types: Fuwai type Cp (innominate or innominate+left carotid artery involvement), Cd (left subclavian or left subclavian+left carotid artery involvement), and Ct (all other AcD).
  • Statistical analysis using Chi-square tests for pairwise comparisons and Kaplan-Meier curves for long-term survival and reoperation-free survival.

Main Results:

  • The study included 1,063 patients: 54 type Cp, 832 type Ct, and 177 type Cd.
  • Surgical mortality was significantly higher in type Ct (9.38%) compared to type Cd (1.69%, p < 0.01) and type Cp (1.85%, p = 0.06).
  • No significant differences were observed in long-term survival rates (p = 0.38) or freedom from aorta-related re-operations (p = 0.19) among the types.

Conclusions:

  • The Fuwai classification effectively distinguishes between different types of aortic arch dissection.
  • Different Fuwai types of AcD exhibit varying surgical mortality rates and necessitate distinct surgical approaches.
  • Despite differences in surgical mortality and methods, all Fuwai types of AcD demonstrate comparable long-term prognoses.