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Original Articles: Adult Cardiac

Mortality in Acute Type A Aortic Dissection: Validation of the Penn Classification

^a Department of Molecular Medicine and Surgery, Cardiothoracic Surgery Unit, The Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
^b Department of Medicine, Atherosclerosis Research Unit, The Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden

Accepted for publication May 2, 2011.

^_* Address correspondence to Dr Olsson, Thoraxkliniken, Karolinska University Hospital, SE17176, Stockholm, Sweden (Email: christian.olsson{at}ki.se).

Background: Intraoperative and in-hospital mortality after surgery for acute type A dissection depends largely on preoperative conditions, specifically the presence of localized or generalized ischemia. Recently, the Penn classification of patients with acute type A aortic dissection has been described. The primary aim was to validate the Penn classification and to investigate preoperative variables related to mortality.

Methods: All consecutive patients operated for acute type A aortic dissection, 1990 to 2009 (n = 360), were included in a retrospective observational study. Univariate and multivariable analyses were used to identify variables related to intraoperative and in-hospital mortality. Propensity scoring was used to adjust for treatment selection bias.

Results: Overall intraoperative mortality was 7% (24 of 360) and in-hospital mortality was 19% (69 of 360). Two hundred nineteen patients (61%) were Penn class Aa (14% in-hospital mortality), 51 (14%) class Ab (24% mortality), 63 (18%) class Ac (24% mortality), and 27 (8%) class Abc (44% mortality), p =0.007. In multivariable analysis, Penn class Ac and Abc were independently related to intraoperative death (odds ratio 5.0 and 5.4, respectively), and Penn class Abc and non-Aa were independently related to in-hospital mortality (odds ratio 3.4 and 2.3, respectively). Concomitant coronary artery bypass grafting, older age, DeBakey type I dissection, and prolonged periods of cardiopulmonary bypass and hypothermic circulatory arrest were also independently associated with mortality.

Conclusions: The Penn classification of acute type A aortic dissection is purposeful and its continued usage encouraged. Penn class indicating localized or generalized ischemia is independently related to intraoperative and in-hospital mortality.

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Invited Commentary

Joshua N. Baker and Thoralf Sundt, III
Ann. Thorac. Surg. 2011 92: 1382-1383. [Extract] [Full Text] [PDF]

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