Five-year mortality in uncomplicated type B aortic dissections with high-risk anatomic features: A 15-year retrospective review
Bibliographic record
Abstract
Objective To evaluate the importance of high-risk anatomic features in the long-term outcomes of patients with acute uncomplicated type B aortic dissections (TBAD) who receive medical management or early thoracic endovascular aortic repair (TEVAR). Methods A retrospective review of all adult patients who were diagnosed with acute uncomplicated TBAD (by Society for Vascular Surgery and Society of Thoracic Surgeons reporting standards) at a Calgary hospital between January 1, 2007, and June 30, 2022, was performed. Anatomic features were analyzed using TeraRecon at diagnosis and at follow-up up to 5 years, and high-risk anatomic features such as an aortic diameter of >40 mm, a false lumen diameter of >22 mm, and a tear on the inner curve are used to risk-stratify patients. The primary outcome was 5-year all-cause mortality and aortic-related mortality. Subgroup analysis was performed for patients with the initial diagnosis of uncomplicated TBAD medically managed with no high-risk features (uTBAD), uncomplicated TBAD medically managed with high-risk anatomic features (uTBAD-HR), and uncomplicated TBAD who received early TEVAR (uTBAD-T), which encompasses patients with both high-risk features and no high-risk features, before the chronic dissection phase. We used the Cox proportional hazards model to analyze the impact of multiple covariates on survival times. Results A total of 41 patients were identified with the diagnosis of acute uncomplicated TBAD during the study period: 19 patients with acute uTBAD, 12 patients with acute uTBAD-HR, and 10 patients with uTBAD-T. The 5-year all-cause mortality and aortic-related mortality in patients with uTBAD-T was 50% and 40%, respectively. Of this subset, patients with high-risk features who received early TEVAR had the worst outcomes, with the all-cause mortality of 80% and aortic-related mortality of 60% at 5 years. All-cause mortality was similar among uTBAD (with thoracic aorta involvement), uTBAD-HR, and uTBAD-T without high-risk features (23.1% vs 25% vs 20%). Maximal descending thoracic aorta diameter and maximal false lumen diameter demonstrated a nonsignificant all-cause mortality trend on survival analysis. Conclusions Real-world data suggest that the role of early TEVAR in patients with acute uncomplicated TBAD remains uncertain. In this small dataset, patients with high-risk anatomic features who received TEVAR before the chronic phase of dissection experienced a higher rate of all-cause and aortic-related mortality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".