VESS10 - Impact of a new dissection classification of Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection

Wednesday, June 4, 2025

2:41 PM – 2:52 PM CT

Location: Morial CC, Second Floor, Room 228-230

Submitting & Presenting Author(s)

YI

Yuki Ikeno, MD

Fellow
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas

Slides

Discussant(s)

Richard A. Meena, MD

Brown University
Providence, Rhode Island

Senior Author(s)

Akiko Tanaka, MD, PhD

Vascular Surgeon
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas

Co-Author(s)

MT

Michael J. Troncone

Fellow
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
EK

Ezra Y. Koh

Fellow
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
HS

Harleen Sandhu

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
CM

Charles C. C. Miller, III, PhD

Professor and Division Chief of Cardiothoracic and Vascular Surgery Research
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas
Hazim J. J. Safi

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
Houston, TX

Senior Author(s)

Anthony L. Estrera

Professor and Chair
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas

Objectives: The traditional Stanford classification for aortic dissection focused on the presence in the ascending aorta whereas the new SVS/STS classification weighed on the location of the tear. Thus, traditional Stanford type A dissection may be an SVS/STS type A or SVS/STS type B0 dissection. We sought the impact of the new classification on the perioperative characteristics and outcomes after acute Stanford type A dissection repair.

Methods: A retrospective review of patients undergoing acute Stanford type A dissection repair between January 1999 and December 2024 was performed. The traditional Stanford type A was reclassified by the SVS/STS classification into its type A and B0 (STS/SVS-A and STS/SVS-B0)
(Figure). Perioperative characteristics, operative outcomes, and survival were compared between SVS/STS-A and SVS/STS-B0. We excluded the patient with unidentified entry tears (SVS/STS type I) from the study.

Results: Among 849 Stanford type A dissection patients, 775 met inclusion criteria, with 617 (79.6%) classified as SVS/STS-A and 158 (20.4%) as SVS/STS-B0. SVS/STS-A patients more frequently presented with malperfusion (A: 42.3% vs. B: 33.5%, p=0.044), hypotension (A: 16.9% vs. B: 10.3%, p=0.029), cardiac arrest (A: 6.2% vs. B: 1.9%, p=0.018), and preoperative intubation (A: 13.6% vs. B: 6.3%, p=0.007). Conversely, SVS/STS-B patients demonstrated larger aortic diameters in the ascending aorta (A: 40.3 ± 6.5 mm vs. B: 42.6 ± 4.8 mm, p=0.006), aortic arch (A: 33.9 ± 5.7 mm vs. B: 36.2 ± 5.7 mm, p=0.003), and descending aorta (A: 30.9 ± 5.0 mm vs. B: 34.5 ± 5.1 mm, p< 0.001).
SVS/STS-A patients more frequently required redo sternotomy (A: 6.8% vs. B: 2.0%, p=0.027) and aortic root replacement (A: 11.5% vs. B: 5.7%, p=0.022), while SVS/STS-B0 patients more often underwent total arch replacement (A: 7.0% vs. B: 22.8%, p< 0.001). Operative mortality was comparable between groups (A: 14.1% vs. B: 13.3%, p=0.792). Ten-year overall survival was 58.3%, with no significant difference between groups (A: 58.7% vs. B: 56.7%, p=0.630). However, freedom from distal reintervention was lower in SVS/STS-B0 patients (A: 75.7% vs. B: 63.4% at 10 years, p=0.005).

Conclusions: STS/SVS type A and SVS/STS type B0 had significant differences in the perioperative characteristics. SVS/STS type B0 dissections had less malperfusion and hypotension but had larger aortic dimensions requiring a higher distal reintervention rate. SVS/STS dissection classification provides valuable insights for both short and long-term outcomes.