Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection

Abstract

Surgery for type A aortic dissection (TAAD) is associated with high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study.Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD).The rates of in-hospital mortality of 3902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure, 10.0%; emergency procedure grade 1, 13.3%; emergency procedure grade 2, 22.1%; salvage procedure grade 1, 45.6%; and salvage procedure grade 2, 57.1% (p<0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model as well as the integrated discrimination indices and the net reclassification indices. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades.In conclusion, the urgency of surgical repair of acute TAAD seems to have a significant impact on the risk of in-hospital mortality may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of patients may survive to discharge.