[Conservative Management of Stanford Type A Acute Aortic Dissection].

Emergency surgery remains the standard of treatment for acute Stanford type A aortic dissection(AAAD), Nevertheless, in real-world practice a minority of patients do not undergo immediate surgery due to clinical constraints, We sought to delineate the outcomes and practical limits of such nonoperative management under strict protocols,

Methods

Of 668 consecutive AAAD patients(Jan 2019~Mar 2025), we retrospectively analyzed 100 who did not receive immediate surgery after excluding 13 with cardiopulmonary arrest, Patients were stratified into a criteria group(C;thrombosed/occluded false lumen in the ascending aorta with ascending diameter≦50 mm and false lumen≦11 mm;n=59)and a non-criteria group(NC;outside these criteria;n=41), The primary endpoint was in-hospital mortality;secondary endpoints included aortic-related death, post-discharge events, and associations with imaging/clinical indices,

Results

NC patients were older and more often female, with larger ascending aortas and false lumens(both p<0.001), In-hospital mortality was 31.7% in NC vs 1.7% in C(p<0.001);48-hour mortality in NC was 12.2%, and aortic-related deaths clustered within 4.56±2.99 days(range 1~12), Seven patients underwent delayed surgery for imaging changes;all survived, Discharge alive occurred in 98.3%(C)and 68.3%(NC), Among those discharged alive, survival up to 2 years was similar, Low body mass index(BMI)and hemodynamically significant tamponade were associated with in-hospital death in NC,

Conclusions

These data support surgery as the default strategy for AAAD, When surgery is unavoidably deferred, conservative management should be considered only in strictly selected patients, with early hemodynamic/computed tomography(CT)triggers for conversion, In NC patients, the first hospital week is the highest-risk window, and low BMI or tamponade should prompt heightened vigilance and a low threshold for intervention.