{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:56:28Z","timestamp":1793836588322,"version":"4.6.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T00:00:00Z","timestamp":1574380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title\/><jats:p\/><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Aortic dissection is complex. Imaging and treatment modalities are evolving, demanding a more differentiated but pragmatic dissection classification. Our goal was to provide a new practical classification system including Type of dissection, location of the tear of the primary Entry and Malperfusion (TEM).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We extended the Stanford dissection classification (A and B) by adding non-A non-B aortic dissection, the location of the primary entry tear (E) and malperfusion (M). A 0 was added if the primary entry tear was not visible; 1, if it was in the ascending aorta; 2, if it was in the arch; and 3, if it was in the descending aorta (E0, E1, E2, E3). We added 0 if malperfusion was absent; 1, if coronary arteries; 2, if supra-aortic vessels; and 3, if visceral\/renal and\/or a lower extremity was affected (M0, M1, M2, M3). Plus (+) was added if malperfusion was clinically present and minus (\u2212) if it was a radiological finding.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The new classification system was analysed in 357 patients retrospectively; distribution was 59%, 31% and 10% for A, B and non-A non-B dissections. The in-hospital mortality rate was 16%, 5% and 8% (P\u2009=\u20090.01). Postoperative stroke occurred in 14%, 1% and 3% (P\u2009&amp;lt;\u20090.001). The in-hospital mortality rate was 22%, 14%, 40% and 0% in A E0, E1, E2 and E3 (P\u2009=\u20090.023), respectively. Two years after the onset of dissection, the lowest survival rate was observed in A, followed by non-A non-B and B (83\u2009\u00b1\u20093% vs 88\u2009\u00b1\u20096% vs 93\u2009\u00b1\u20093%; P\u2009=\u20090.019).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The new practical TEM aortic dissection classification system adds clarity regarding the extent of the disease process, enhances awareness of the disease mechanism, aids in decision-making regarding the extent of repair and helps in anticipating outcome.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivz281","type":"journal-article","created":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T20:56:34Z","timestamp":1572555394000},"page":"451-457","source":"Crossref","is-referenced-by-count":183,"title":["Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction"],"prefix":"10.1093","volume":"30","author":[{"given":"Hans-Hinrich","family":"Sievers","sequence":"first","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Medical Centre Schleswig-Holstein, Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz","family":"Rylski","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L M","family":"Baier","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3099-7254","authenticated-orcid":false,"given":"Maximilian","family":"Kreibich","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-9343","authenticated-orcid":false,"given":"Matthias","family":"Siepe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2975-2751","authenticated-orcid":false,"given":"Friedhelm","family":"Beyersdorf","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,22]]},"reference":[{"key":"2020022609295236200_ivz281-B1","doi-asserted-by":"crossref","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d47d48","article-title":". 2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"2020022609295236200_ivz281-B2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0003-4975(10)65594-4","article-title":"Management of acute aortic dissections","volume":"10","author":"Daily","year":"1970","journal-title":"Ann Thorac Surg"},{"key":"2020022609295236200_ivz281-B3","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0022-5223(19)33323-9","article-title":"Surgical management of dissecting aneurysms of the aorta","volume":"49","author":"DeBakey","year":"1965","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020022609295236200_ivz281-B4","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/S0022-5223(94)70304-3","article-title":"Dissection of the descending thoracic aorta extending into the ascending aorta. 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