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Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection
Naoyuki Kimura1, Tetsu Ohnuma2, Satoshi Itoh1
1Department of Cardiovascular Surgery, Jichi Medical University, Saitama Medical Center, Saitama, Japan.
Insights
The Penn classification effectively predicts outcomes for acute type A aortic dissection (AAAD) surgery. Higher Penn classes, indicating more severe ischemia, correlate with increased mortality and complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection (AAAD) is a life-threatening condition requiring prompt surgical intervention.
- Risk stratification is crucial for optimizing surgical outcomes in AAAD patients.
- The Penn classification system categorizes AAAD based on preoperative ischemia.
Purpose of the Study:
- To evaluate the predictive value of the Penn classification for surgical outcomes in patients with DeBakey type I AAAD.
- To assess the association between Penn classification groups and in-hospital mortality, complications, and long-term survival.
Main Methods:
- Retrospective analysis of 351 patients with DeBakey type I AAAD undergoing surgery between January 1997 and January 2011.
- Patients were stratified into four Penn classification groups (Aa, Ab, Ac, Abc) based on ischemic conditions.
- Comparison of early (in-hospital mortality, complications) and late (5-year survival) outcomes across the four groups.
Main Results:
- In-hospital mortality rates increased with Penn class: 3% (Aa), 6% (Ab), 17% (Ac), and 22% (Abc).
- Penn classes Ac and Abc, prolonged operation time (>6 hours), and descending thoracic aorta entry were significant risk factors for in-hospital mortality.
- Five-year cumulative survival was significantly lower in higher Penn classes (Aa: 85%, Ab: 74%, Ac: 78%, Abc: 67%).
Conclusions:
- The Penn classification is a valuable tool for risk assessment in AAAD surgery.
- Patients with generalized ischemia (Penn classes Ac and Abc) face significantly higher morbidity and mortality.
- The classification effectively predicts both early and late outcomes following surgical repair of AAAD.
Abstract:
The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, January 1997 to January 2011, were divided into 4 groups per Penn class: Aa (no ischemia, n = 187), Ab (localized ischemia with branch malperfusion, n = 67), Ac (generalized ischemia with circulatory collapse, n = 46), and Abc (localized and generalized ischemia, n = 51). Early and late outcomes were compared between groups. In-hospital mortality was 3% (6 of 187) for Penn Aa, 6% (4 of 67) for Penn Ab, 17% (8 of 46) for Penn Ac, and 22% (11 of 51) for Penn Abc. Multivariate logistic regression analysis showed Penn classes Ac and Abc, operation time >6 hours, and entry in the descending thoracic aorta to be risk factors for in-hospital mortality. Incidences of neurologic, respiratory, and hepatic complications differed between groups. Five-year cumulative survival was 85% in the Penn Aa group, 74% in the Penn Ab group (p = 0.027 vs Penn Aa), 78% in the Penn Ac group, and 67% in the Penn Abc group (p <0.001 vs Penn Aa). In conclusion, morbidity and mortality are high in patients with generalized ischemia. The Penn classification appears to be a useful risk assessment system for AAAD, predictive of outcomes.
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