Mortality in acute type A aortic dissection - A systematic review based on contemporary registries

Acute type A aortic dissection (ATAAD) remains one of the most time-critical cardiovascular emergencies, with early mortality continuing to pose substantial clinical and organizational challenges. Large-scale observational registries offer valuable insights into real-world outcomes across healthcare systems.

To synthesize and compare early mortality rates in patients with ATAAD as reported by national and multicentre registries.

A structured search was conducted in PubMed, Google Scholar and the Cochrane Library for studies published within the last 10 years. We included registry-based studies reporting in-hospital, 30-day, operative or 48-hour mortality following ATAAD. Study characteristics, demographic profiles and preoperative risk factors were extracted.

A total of 20 studies, comprising 77,267 patients, were included. In-hospital mortality was reported in 13 registries (n = 50,470), with rates ranging from 5% to 29%. Thirty-day mortality was reported in 5 registries (n = 19,521) and operative mortality in 2 registries (n = 14,825). Substantial variation in outcome definitions and case inclusion criteria limited direct comparability.

Early mortality in ATAAD remains high and heterogeneous across registries. Strengthening global registry participation and adopting standardized reporting practices are essential steps toward improving risk stratification, guiding clinical decisions, and advancing equitable care in ATAAD.