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Aortic dissection type A versus type B: a different post-surgical death hazard?

G Rizzoli1, D Scalia, D Casarotto

  • 1Istituto Chirurgia Cardiocascolare, University of Padova, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|August 1, 1997
PubMed

Insights

Patients with type B aortic dissection face a higher postoperative death risk than type A, despite similar long-term survival rates. This increased hazard in type B dissections may stem from expansion, malperfusion, or treatment limitations.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Type A and Type B aortic dissections present distinct patient demographics and treatment indications.
  • Previous studies suggested similar long-term outcomes for both dissection types.
  • Understanding post-surgical differences is crucial for managing aortic dissection patients.

Purpose of the Study:

  • To compare the long-term post-surgical outcomes of Type A and Type B aortic dissections.
  • To investigate the hazard function and survival rates following surgical intervention for aortic dissection.
  • To identify potential factors contributing to differences in post-operative risk.

Main Methods:

  • Retrospective review of 288 consecutive aortic dissection surgeries (213 Type A, 75 Type B) between 1970 and 1994.
  • 100% complete patient follow-up.
  • Application of fully parametric methods to interpolate empirical survival and analyze hazard functions.

Main Results:

  • No significant difference in overall survival between Type A and Type B dissections at 20 years (31% vs. 24%, P=NS).
  • Type A dissections exhibited a constant late risk (3.9% patient-years).
  • Type B dissections showed an intermediate risk phase (4-10 years) with an average linearized risk of 9.3% patient-years, peaking at 20%.

Conclusions:

  • Patients with Type B aortic dissection experience a steeper postoperative death hazard compared to Type A.
  • This disparity is not explained by age or late entry bias.
  • Potential causes include increased propensity for aortic expansion, higher risk of malperfusion, or limitations in current surgical treatments.
Abstract

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