Overall survival, cause of death and time interval between diagnosis and death after type B acute aortic dissection (TBAAD)

Objectives: This study aimed to assess survival rates and the causes of both early and late mortality in patients with Stanford type B aortic dissection (TBAAD).

Methods: A retrospective analysis was conducted on all consecutive patients presenting with TBAAD from 2000 to 2018 at a single tertiary care center. The primary end-point was early (<3 months) and late (>3 months) survival following TBAAD, with causes of both early and late mortality evaluated.

Results: A total of 274 patients, with a mean age of 64 ± 13 years, were included. Among these, 155 patients (57%) presented with uncomplicated TBAAD, including 52 (19%) identified as high-risk, and 119 patients (43%) had complicated TBAAD. Early aorta-related mortality occurred in nine patients (3.3%), all within the complicated TBAAD group. The median follow-up period for the entire cohort was 8.5 years (95% CI: 7.6-11.2). Long-term survival was significantly higher in patients with uncomplicated TBAAD compared to those with complicated TBAAD (p < 0.001). Both complicated and high-risk uncomplicated TBAAD cases required significantly more interventions in the chronic phase (>3 months) compared to uncomplicated TBAAD cases (HR 9.8, 95% CI 6.4-15.4, p < 0.001; HR 3.3, 95% CI 2.1-5.1, p < 0.001).

Conclusions: Complicated TBAAD presents the greatest risk for aorta-related mortality and interventions. Patients with high-risk uncomplicated TBAAD are also notable for an increased rate of aorta-related mortality and interventions. Thorough evaluation of clinical and anatomical characteristics is essential for determining the optimal therapeutic approach.