What is the survival rate for an adult with no significant past medical history diagnosed with type B aortic dissection?

Survival Rate of Type B Aortic Dissection

Type B aortic dissection has an in-hospital mortality of approximately 14% with medical management, with 1-year survival of 70% and 2-year survival of 60%. 1

Acute Phase Mortality (First 30 Days)

The most recent ESC guidelines report that in-hospital mortality for acute type B aortic dissection has remained stable at 14% over recent decades, which is substantially better than type A dissection. 1 However, when including deaths before hospital admission, 30-day mortality ranges from 23% to 55.8% in Western Europe. 1

Complicated vs. Uncomplicated Disease

The distinction between complicated and uncomplicated dissection dramatically affects survival:

• Uncomplicated type B dissection treated medically has a 30-day mortality of approximately 2.4%. 2
• Complicated type B dissection (with rupture, malperfusion, uncontrolled hypertension, or rapid expansion) has significantly higher mortality:
  • TEVAR treatment: 7.3% 30-day mortality 2
  • Open surgical repair: 19.0% 30-day mortality 2
  • Medical therapy alone: 14% 30-day mortality 1

Initial Hospitalization Outcomes

In patients receiving initial conservative medical treatment, hospital mortality is 17.6%, with main causes of death being rupture (42%), intestinal malperfusion (39%), and cardiac failure (9%). 3 An additional 5% of medically managed patients require conversion to early surgery during initial hospitalization due to complications. 3

Long-Term Survival

1-5 Year Outcomes

The European Cooperative study demonstrated:

• 1-year survival: 70% 1
• 2-year survival: 60% 1
• 5-year survival: 50-80% depending on management strategy 4

After primary conservative therapy, actuarial survival rates are 76% at 5 years and 50% at 8 years. 3

Factors Affecting Long-Term Prognosis

The degree of communication between true and false lumens significantly impacts survival, with best prognosis found in non-communicating and retrograde type B dissection limited to the descending aorta (80-86% 2-year survival). 1

Independent predictors of long-term mortality include:

• Renal insufficiency (OR 4.7) 5
• Coexistent aortic disease (OR 4.1) 5
• Partial false lumen thrombosis 4
• Aortic diameter >5 cm at presentation 3

Late Complications Affecting Survival

Despite surviving the acute phase, 25-30% of patients develop aortic aneurysm formation within 4 years, requiring delayed surgical intervention. 4 Surgery for chronic dissection carries an 8% hospital mortality. 3

Spontaneous healing of type B dissection is rare (occurring in only 7-31% depending on imaging modality), particularly when large entry tears maintain continuous flow through the false lumen. 1

Critical Prognostic Considerations

High-Risk Features Requiring Intervention

Patients with the following features have worse outcomes and may benefit from early TEVAR rather than medical management alone:

• Age <60 years with aortic diameter ≥5 cm 3
• Marfan syndrome 3
• Limited false aneurysm or retrograde dissection into aortic arch 3
• Poor medical compliance or uncontrollable proximal hypertension 3

TEVAR vs. Medical Management

The INSTEAD-XL trial showed that while 2-year outcomes were similar, at 5 years TEVAR demonstrated lower aorta-related mortality (6.9% vs. 19.3%) and disease progression (27.0% vs. 46.1%) compared to medical therapy alone. 1 However, total mortality showed no difference. 1

Common Pitfalls

Delay in diagnosis significantly worsens outcomes, as only 15% of cases were diagnosed before death in historical population-based studies. 1

Shock due to rupture is strongly associated with in-hospital mortality (p=0.006), making rapid hemodynamic stabilization critical. 5

The survival advantage of type B over type A dissection (70% vs. 52% at 1 year) can create false reassurance—long-term vigilance is essential as 30% develop morbidity including aneurysm degeneration over 5 years despite surviving the acute phase. 6