Outcome

Most patients with dissection have another pathology which will contribute to a reduction in life expectancy. The short-term in-hospital mortality for type A dissections treated rapidly by surgery has fallen from 20 to 40 per cent to below 10 per cent in several series. The in-hospital mortality for type B dissections treated medically is approximately 20 per cent. The initial mortality for patients with type B dissections treated surgically is higher, largely because most such patients do not receive surgery unless severe complications develop. Although only 50 per cent will survive for a year, the excess mortality is almost all related to surgery; the slope of the survival curve for those leaving hospital is similar to that for those managed medically. Longer-term outcome is less clear; overall 10-year actuarial survival for all dissections is approximately 40 per cent, but this will probably improve as the results from recent series are analyzed. Operations for subsequent complications will be required in up to 23 per cent of patients who leave hospital. These include aneurysm formation and the development of severe aortic regurgitation. Of those who die subsequently, in nearly 30 per cent the cause will be development and rupture of an aneurysm, emphasizing the need for long-term follow-up of these patients.

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