Impact of the society for vascular surgery/society of thoracic surgeons classification on prognosis and therapeutic strategies in acute Stanford type A aortic dissection.

OBJECTIVE

The Stanford classification does not differentiate between antegrade and retrograde primary entry tears in acute Stanford type A aortic dissection (ATAAD). The 2020 Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification categorizes ATAAD into SVS/STS-A and SVS/STS-B0 based on the location of the primary entry tear; however, its clinical utility requires further validation. This study aims to evaluate the impact of the SVS/STS-A and SVS/STS-B0 on the prognosis and strategies for ATAAD.

METHODS

We retrospectively reviewed 931 consecutive ATAAD patients at Union Hospital (Wuhan, China) from June 2012 to August 2025. According to the SVS/STS classification criteria, patients were classified as the SVS/STS-A (n = 743) and SVS/STS-B0 (n = 188) dissection. Baseline demographics, aortic anatomical features, treatment strategies, and clinical outcomes were compared between the two groups.

RESULTS

The SVS/STS-A patients had more severe proximal aortic pathology, while the SVS/STS-B0 patients had more extensive distal involvement. The SVS/STS-A group underwent more aortic root replacement (36.8% vs. 7.7%, P < 0.001), aortic valve replacement (35.7% vs. 9.9%, P < 0.001), and coronary artery bypass grafting (35.1% vs. 9.2%, P < 0.001). In contrast, the SVS/STS-B0 group underwent more total arch replacement (78.2% vs. 65.1%, P = 0.012) and the stented elephant trunk procedure (78.9% vs. 59.1%, P < 0.001). In the overall cohort, the SVS/STS-A group demonstrated higher 24 h mortality (9.8% vs. 1.1%, P < 0.001), in-hospital mortality (24.2% vs. 14.4%, P = 0.004), and 3-year all-cause mortality (31.70% vs. 17.80%, P = 0.0005) compared to the SVS/STS-B0 group. In the open surgery subgroup, no significant prognostic difference existed between the two types. In the non-surgery subgroup, the SVS/STS-A group had significantly higher 24 h mortality (31.6% vs. 5.7%, P = 0.002) and in-hospital mortality (49.5% vs. 8.6%, P < 0.001).

CONCLUSIONS

The SVS/STS classification provides effective preoperative risk stratification for ATAAD. The SVS/STS-A dissections carry a higher early mortality risk, necessitating urgent surgical intervention with aggressive management of the aortic root. In contrast, the SVS/STS-B0 dissections allow a wider surgical window, with strategies emphasizing arch replacement and distal remodeling.