Abstract 16619: Acute Aortic Dissection With No Ascending Involvement: Is Entry Tear Location in the Arch Different From Entry Tear Location in the Descending?
Bibliographic record
Abstract
Introduction: Optimal management of acute aortic dissections (AD) with entry tear in the arch without ascending involvement (arch B AD) is not discussed in clinical guidelines. This study aims to better define this type of AD. Methods: Presentation, management, and in-hospital mortality of patients with arch B AD enrolled in the International Registry of Acute Aortic Dissection were analyzed and compared to a control group of Stanford type B AD (TBAD) with entry tear in the descending aorta. Results: Patients with arch B AD (n=156) and TBAD (n=222) were not significantly different concerning demographics, except age, which was higher in TBAD patients (60±14 vs 64±14 years; p=0.024). Medical history, including hypertension, diabetes, bicuspid aortic valve, Marfan disease, renal insufficiency and COPD, was similar for both groups. On preoperative imaging, arch B AD patients had a larger median arch diameter (3.7 vs 3.5 cm; p=0.007) and smaller descending diameter (3.6 vs. 4.4 cm; p<0.001). The two groups were not different concerning preoperative complications such as shock, aortic rupture or neurological complications, except descending diameter >5.5 cm, which was less frequently seen for arch B AD (2.6% vs 13.5%; p<0.001). Arch B AD was more frequently treated with open surgery (19.9% vs. 10.8%; p=0.013) and less frequently managed medically (47.4% vs. 61.4%; p=0.007), while the frequency of endovascular treatment was similar (26.3% vs. 26.0%; P=0.953). The overall in-hospital mortality was higher for arch B AD (17.3% vs. 12.6%; p=0.196). This difference was driven primarily by those receiving open surgery (32.3% mortality for arch B AD vs. 16.7%; p=0.226), while mortality was similar after endovascular treatment (9.8% vs. 8.6%; p=1.0), and medical management (13.5% vs. 14.1%; p=1.0). Conclusions: Arch B AD is more frequently treated aggressively with open surgery, but associated mortality rates are high. A more conservative approach with either endovascular treatment or medical management may be preferable. In this respect, arch B AD may be comparable to TBAD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".