Prognosis

Syncope at presentation is usually associated with worse outcomes. A deadly triad of hypotension/shock (not syncope), lack of chest or back pain (presumably related to delay in diagnosis), and branch vessel involvement is also described.[73]

Left untreated, the natural history of proximal acute aortic dissection is of false channel rupture with fatal exsanguination in 50% to 60% of patients within 24 hours.[74]​ Patients with non-operated type A dissection rarely live past the acute event.[5]​ In tertiary high-volume referral centers for aortic diseases, the surgical mortality for ascending and hemiarch replacement with or without root replacement is as low as 10% to 20%.[5]

The midterm survival of surgically corrected ascending dissections at 1, 3, and 5 years is 95%, 93%, and 89%, respectively.[5]​ The 10-year survival after surgery of ascending aortic dissection is 52%. Freedom from re-operation at both 5 and 10 years ranges from 59% to 95%.[75][Figure caption and citation for the preceding image starts]: Dissection status post-proximal repair with late distal aneurysm [Citation ends].Dissection status post-proximal repair with late distal aneurysm

Patients with uncomplicated type B dissection (i.e., those without signs of rupture, rapid expansion, or branch vessel malperfusion; approximately 60% to 70% of type B dissections) can be safely managed medically. Almost all patients with initially uncomplicated type B dissection therefore progress to the chronic phase with a 20% to 50% risk of late adverse events.[5]​ Complicated type B dissections (ie, those requiring urgent endovascular or surgical repair for aortic rupture, rapid expansion, or branch vessel malperfusion, as well as those patients too sick to undergo an acute intervention) represent approximately 0% to 40% of type B dissections. The in-hospital mortality of these patients is approximately 20%.[5]​ Late degeneration of the dissected aorta into a false lumen aneurysm occurs in 30% to 50% of patients.[62]​ Following treatment, patients remain at risk for further aneurysmal degeneration of remaining diseased aorta.

The 5-year survival after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection is 81%.[76] 

Longer term outcomes after TEVAR for the treatment of either acute or chronic type B aortic dissection are currently unknown.

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