University of Oulu

Johanna Herajärvi, Caius Mustonen, Risto Kesävuori, Peter Raivio, Fausto Biancari, Mikko Jormalainen, Tatu Juvonen, Impact of high-risk features on outcome of acute type B aortic dissection, JTCVS Open, Volume 13, 2023, Pages 20-31, ISSN 2666-2736,

Impact of high-risk features on outcome of acute type B aortic dissection

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Author: Herajärvi, Johanna1,2; Mustonen, Caius1,2; Kesävuori, Risto1,3;
Organizations: 1Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Research Unit of Surgery, Anesthesia, and Critical Care, University of Oulu, Oulu, Finland
3Department of Radiology, Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Elsevier, 2023
Publish Date: 2023-08-21


Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent.

Methods: This analysis includes patients treated for acute TBAD at the Helsinki University Hospital, Finland between 2007 and 2019. The endpoints were early and late mortality, intervention of the aorta, and a composite of death and aortic intervention in uncomplicated patients and high-risk patients.

Results: This study included 162 consecutive TBAD patients (27.8% females), 114 in the high-risk group and 48 in the uncomplicated group, with a mean age of 67.6 ± 13.9 years. Intramural hematoma was reported in 63 cases (38.9%). The mean follow-up was 5.1 ± 3.9 years. In-hospital/30-day mortality (n = 4; 3.5%) occurred solely in the high-risk group (P = 0.32). Additionally, TBAD-related adverse events (n = 23; 20.2%) were observed only in the high-risk group (P < 0.001). The cumulative incidences of the composite TBAD outcome with non–TBAD-related death as a competing risk were 6.6% (95% CI, 1.7%–16.5%) in the uncomplicated group and 29.5% (95% CI, 21.1%–38.3%) in the high-risk group at 5 years and 6.6% (95% CI, 1.7%–16.5%) and 33.0% (95% CI, 23.7%–42.6%) at 10 years (P = 0.001, Gray test). Extracardiac arteriopathy (subdistribution hazard ratio [SHR], 2.61; 95% CI, 1.08–6.27) and coronary artery disease (SHR, 2.24; 95% CI, 1.07–4.71) were risk factors for adverse aortic-related events in univariable competing-risk regression analysis.

Conclusions: Recognition of risk factors underlying adverse events related to TBAD is essential because the disease progression impacts both early and late outcomes. Early aortic repair in high-risk TBAD may reduce long-term morbidity and mortality.

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Series: JTCVS open
ISSN: 2666-2736
ISSN-E: 2666-2736
ISSN-L: 2666-2736
Volume: 13
Pages: 20 - 31
DOI: 10.1016/j.xjon.2023.01.005
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Copyright information: © 2023 The Author(s). Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. This is an open access article under the CC BY-NC-ND license (