Document Detail

Mortality in acute type A aortic dissection: validation of the Penn classification.
MedLine Citation:
PMID:  21855849     Owner:  NLM     Status:  MEDLINE    
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.
Christian Olsson; Carl-Gustaf Hillebrant; Jan Liska; Ulf Lockowandt; Per Eriksson; Anders Franco-Cereceda
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2011-08-19
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  92     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-30     Completed Date:  2011-11-29     Revised Date:  2012-11-20    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1376-82     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Molecular Medicine and Surgery, The Karolinska Institute, Stockholm, Sweden.
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MeSH Terms
Acute Disease
Aged, 80 and over
Aneurysm, Dissecting / classification*,  mortality,  surgery
Aortic Aneurysm, Thoracic / classification*,  mortality,  surgery
Hospital Mortality / trends
Intraoperative Period
Middle Aged
Postoperative Period
Retrospective Studies
Risk Assessment / methods*
Survival Analysis
Survival Rate / trends
Sweden / epidemiology
Vascular Surgical Procedures / mortality*
Young Adult
Comment In:
Ann Thorac Surg. 2012 Oct;94(4):1376   [PMID:  23006709 ]
Ann Thorac Surg. 2011 Oct;92(4):1382-3   [PMID:  21958784 ]

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