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

Penn classification in acute aortic dissection patients

“…The University of Pennsylvania group 13,18 introduced this classification system and categorized 221 AADA patients (mean age, 62 years, treated between 1993 and 2004) into four groups as follows: Aa (58%), Ab (18%), Ac (15%), Abc (9%). The Karolinska group 14 categorized 360 AAAD patients (mean age, 60 years, treated between 1990 and 2009) into Aa (61%), Ab (14%), Ac (18%) and Abc (7%). Distribution of the Penn classes in our study (Aa 48%, Ab 19%, Ac 9%, Abc 24%) showed a higher number of patients with both branch vessel malperfusion and circulatory collapse.…”

“…When necessary, cerebral protection was performed with deep hypothermic circulatory arrest (DHCA) alone or with DHCA and retrograde cerebral perfusion. The surgical techniques we followed have been described previously 8,[14][15][16][17][18] . Briefly, we applied the tear-oriented strategy, that is, ascending aorta replacement (or hemiarch replacement) and resection of the primary entry were performed by means of open distal anastomosis during deep hypothermic circulatory arrest at a rectal temperature of 20°C.…”

Total aortic repair for acute type A aortic dissection: a new paradigm

“…Understandably, the acute salvage is strongly influenced by the occurrence and extent of pre-operative complications such as shock and various organ malperfusion, as conveniently summarised by the Pennsylvania University classification (4). Nevertheless, this cannot be the whole explanation, as demonstrated in a series of 360 patients operated on for ATAAD from Olsson et al (5), where the mortality was still 14% in the most frequent (61%) and lowest risk (Penn Aa) subgroup, where one would have expected an outcome approaching that of an elective operation.…”

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

“…Recently, the surgical outcomes for AAAD have been improved. [1][2][3][4][5] Endovascular repair has also been reported to lead to acceptable results. 11,12) However, it is still difficult to rescue some patients who have fallen into hypotensive shock and critical branch ischemia, such as cerebral infarction, myocardial infarction and intestinal infarction.…”

“…[1][2][3][4][5] However, it is still difficult to rescue patients who have fallen into hypotensive hypotensive shock and critical branch ischemia, such as cerebral infarction, myocardial infarction and intestinal infarction. In the case of critical organ ischemia, the rapid establishment of the cardiopulmonary bypass (CPB) for organ perfusion and systemic cooling is essential to save the patient.…”