Life expectancy in aortic dissection
Life expectancy in aortic dissection depends largely on whether type A or B is present, with type B generally having a better prognosis. In addition, life expectancy naturally depends on the patient’s previous illnesses and clinical condition at the time of the acute event. In addition, a ruptured dissection (type A or B) without immediate emergency medical treatment has a very poor prognosis from a few minutes to a maximum of hours or days.
Without surgery, the mortality rate of a type A dissection increases by about 1% per hour. On the other hand, if these patients have survived the operation and the critical days and weeks afterwards, they still have a relatively age-appropriate life expectancy as long as no late complications occur. With type B dissections, life expectancy is quite good, except for ruptured dissections. About 80-90% survive the first year with conservative treatment and complications can often be treated with interventional methods (catheters and stents). If the course of the disease is uncomplicated, life expectancy is usually not drastically reduced.
New surgical techniques and advances in emergency medicine have dramatically improved the prognosis of aortic dissections. Nevertheless, acute aortic dissection remains a dangerous clinical picture with relatively high mortality. Approximately 20% of patients do not reach the hospital alive after the acute clinical picture.
A further 20 to 25% die in the hospital before the diagnosis is made. Without therapy, the mortality rate increases by one percent per hour. Early detection of the emergency is therefore crucial for the prognosis, so that an operation can be initiated before there is a reduced supply to the brain, intestine or extremities or serious cardiac complications occur.
In addition, it is crucial whether the dissection has already ruptured, which drastically worsens the prognosis. Whereas previously only 1 to 2 out of 10 patients with type A dissection survived the first week and hardly any survived the first year, today 90% of patients survive surgery and 80% survive the following month. Without surgery, only about half of the patients with type A dissection survive the first month after the acute event. In contrast, 80-90% of patients with type B dissection survive the first year under purely drug therapy.