Impact of new classification from the Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection

Abstract

Objectives: The Stanford classification categorizes aortic dissection based on ascending aortic involvement, whereas the newer Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification emphasizes tear location. Thus, traditional Stanford type A dissection may be an SVS/STS type A dissection or SVS/STS type B0 dissection. We evaluated the impact of SVS/STS classification on perioperative characteristics and outcomes after acute Stanford type A dissection repair.

Methods: We retrospectively reviewed 794 patients undergoing acute Stanford type A dissection repair between January 1999 and March 2025, excluding those with unidentified entry tears (SVS/STS type I). Perioperative variables and outcomes were compared between SVS/STS type A (n = 632) and type B0 (n = 162).

Results: SVS/STS type B0 patients had lower rates of malperfusion and hypotension but larger arch, descending, and abdominal aortic diameters. Operative mortality was similar between groups (13.9% vs 14.8%; P = .778). Long-term survival did not differ significantly (10-year survival, 59.3% vs 54.5%; P = .277). However, freedom from distal aortic reintervention was significantly lower in the SVS/STS type B0 group (76.2% vs 65.3% at 10 years; P = .008).

Conclusions: The SVS/STS classification identifies distinct subgroups within Stanford type A dissection. SVS/STS type B0 dissections present with more stable hemodynamics but larger aortic dimensions and higher distal reintervention rates. This classification provides valuable prognostic information for both early and late outcomes.

Keywords: Classification; SVS/STS; Society for Vascular Surgery; Society of Thoracic Surgeons; Stanford type A aortic dissection.