Mortality in acute type A aortic dissection: validation of the Penn classification

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• Intraoperative and in-hospital mortality in acute type A aortic dissection (aTAAD) are significantly influenced by preoperative ischemic conditions.
• The recently developed Penn classification system aims to stratify aTAAD patients based on these preoperative factors.
• Validating this classification is essential for refining risk assessment and surgical planning.

Purpose of the Study:

• To validate the prognostic utility of the Penn classification for patients undergoing surgery for aTAAD.
• To identify preoperative variables, including those within the Penn classification, that are independently associated with intraoperative and in-hospital mortality.

Main Methods:

• A retrospective observational study included 360 consecutive patients operated for aTAAD between 1990 and 2009.
• Univariate and multivariable logistic regression analyses were employed to determine predictors of mortality.
• Propensity scoring was utilized to mitigate potential treatment selection bias.

Main Results:

• Overall intraoperative mortality was 7% and in-hospital mortality was 19%.
• Higher Penn classification categories (Ac and Abc) were significantly associated with increased intraoperative and in-hospital mortality.
• Concomitant coronary artery bypass grafting, advanced age, DeBakey type I dissection, and extended cardiopulmonary bypass times were also linked to higher mortality rates.

Conclusions:

• The Penn classification is a valuable tool for stratifying risk in aTAAD patients, particularly concerning localized or generalized ischemia.
• The classification demonstrates independent predictive value for both intraoperative and in-hospital mortality.
• Continued use of the Penn classification is encouraged to guide clinical decision-making and improve surgical outcomes in aTAAD.