Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction
Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction
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DOI：
10.1093/icvts/ivz281
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发表时间：
2020-03-01
影响因子：
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通讯作者：
Beyersdorf, Friedhelm
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文献类型：
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作者：
Sievers, Hans-Hinrich;Rylski, Bartosz;Beyersdorf, Friedhelm
结论：主动脉夹层很复杂。影像学和治疗方式不断发展，需要一个更有区别但更实用的解剖分类。我们的目标是提供一个新的实用的分类系统，包括夹层类型，撕裂的位置的主要入口和灌注不良（TEM）。方法：我们扩展了斯坦福大学夹层分类（A和B），增加了非A非B主动脉夹层，位置的主要入口撕裂（E）和灌注不良（M）。如果原发性入口撕裂不可见，则添加0;如果在升主动脉中，则添加1;如果在弓部中，则添加2;如果在降主动脉中，则添加3（E0、E1、E2、E3）。如果不存在灌注不良，则添加0;如果冠状动脉，则添加1;如果主动脉上血管，则添加2;如果内脏/肾脏和/或下肢受累，则添加3（M0、M1、M2、M3）。加（+），如果灌注不良是临床上存在和减（-），如果它是一个放射finding.Results：新的分类系统进行了分析，在357例回顾性分布为59%，31%和10%的A，B和非A非B夹层。住院死亡率分别为16%、5%和8%（P = 0.01）。术后脑卒中发生率分别为14%、1%和3%（P < 0.001）。A E0、E1、E2和E3的住院死亡率分别为22%、14%、40%和0%（P = 0.023）。发病后2年，A组的生存率最低，其次为非A非B和B（83 +/- 3% vs 88 +/- 6% vs 93 +/- 3%; P = 0.019）。新的实用TEM主动脉夹层分类系统增加了关于疾病过程的程度的清晰度，提高了对疾病机制的认识，辅助有关修复程度的决策，并有助于预测结果。
OBJECTIVES: Aortic dissection is complex. Imaging and treatment modalities are evolving, demanding a more differentiated but pragmatic dissection classification. Our goal was to provide a new practical classification system including Type of dissection, location of the tear of the primary Entry and Malperfusion (TEM).METHODS: We extended the Stanford dissection classification (A and B) by adding non-A non-B aortic dissection, the location of the primary entry tear (E) and malperfusion (M). A 0 was added if the primary entry tear was not visible; 1, if it was in the ascending aorta; 2, if it was in the arch; and 3, if it was in the descending aorta (E0, E1, E2, E3). We added 0 if malperfusion was absent; 1, if coronary arteries; 2, if supra-aortic vessels; and 3, if visceral/renal and/or a lower extremity was affected (M0, M1, M2, M3). Plus (+) was added if malperfusion was clinically present and minus (-) if it was a radiological finding.RESULTS: The new classification system was analysed in 357 patients retrospectively; distribution was 59%, 31% and 10% for A, B and non-A non-B dissections. The in-hospital mortality rate was 16%, 5% and 8% (P = 0.01). Postoperative stroke occurred in 14%, 1% and 3% (P < 0.001). The in-hospital mortality rate was 22%, 14%, 40% and 0% in A E0, E1, E2 and E3 (P = 0.023), respectively. Two years after the onset of dissection, the lowest survival rate was observed in A, followed by non-A non-B and B (83 +/- 3% vs 88 +/- 6% vs 93 +/- 3%; P = 0.019).CONCLUSIONS: The new practical TEM aortic dissection classification system adds clarity regarding the extent of the disease process, enhances awareness of the disease mechanism, aids in decision-making regarding the extent of repair and helps in anticipating outcome.