Abstract
Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications.Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation.Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19).Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.
Highlights
Aortic dissection is a life-threatening medical emergency with a 10% to 20% risk of in-hospital mortality [1,2,3]
The traditional classification was not able to respond to operation methods for arch dissection (AcD) patients
We explored whether the new aortic dissection classification could help in the selection of operation methods
Summary
Aortic dissection is a life-threatening medical emergency with a 10% to 20% risk of in-hospital mortality [1,2,3]. The DeBakey and Stanford classifications are the most commonly used methods to categorize aortic dissection. These two classifications have unclear definitions for aortic arch dissection (AcD), especially when the distal aortic arch is involved. Fuwai Classification Distinguish Arch Dissection the distal aortic arch dissection as non-A-non-B dissection [4]. This naming method was not widely accepted, and the therapeutic strategy did not reach a conclusion, partly because there was no unified definition. We propose the Fuwai classification for AcD to distinguish differences in aortic arch involvement and guide in the selection of an operation method [7]
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