Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification

Abstract

The Penn classification of acute type A aortic dissection enabled stratification of patients by operative mortality risk. The system requires further validation, but might facilitate new ways to analyze mortality data for this disorder.

The DeBakey classification exactly reflects late outcome and re-intervention probability in acute aortic dissection with a slightly modified type II definition

“…Actuarial survival after 5 years was better for type II patients (80% vs 63% for type I), but did not reach statistical significance. Augoustides et al from Penn State University also suggest a modification of the dissection classification to better define the clinical status at presentation [22]. This classification defines patients according to the ischemic and circulatory complications aiming at a patient selection for an additional endovascular management.…”

Penn classification in acute aortic dissection patients

“…Several recent reports highlight the crucial role of preoperative malperfusion and ischaemia, localized or generalized as in shock, as predictors of adverse surgical outcome [9][10][11][12] . Specifically, the Penn classification of acute aortic dissection, based on preoperative ischaemic conditions, has recently been described 13,18 . The present study aims to evaluate the efficiency of the Penn classification in predicting in-hospital mortality and outcomes in a cohort of consecutive patients operated for AADA.…”

“…The Penn classification 13 is a recent method to evaluate the clinical presentation of type A dissection. Class Aa is characterized by absence of branch vessel malperfusion or circulatory collapse.…”

“…Two main single-centre studies have evaluated the validity of the Penn classification. 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%).…”

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

“…Independent preoperative predictors of poor outcome after repair of Stanford type A aortic dissection are age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100mmHg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction [39]. Generalized and localized ischemia seem to have a major role as preoperative predictors of intraoperative and in-hospital mortality [40,41].…”