Utility of the Penn Classification in Predicting Outcomes of Surgery for Acute Type A Aortic Dissection

The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, Janua...

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Published in:The American journal of cardiology 2014-02, Vol.113 (4), p.724-730
Main Authors: Kimura, Naoyuki, MD, PhD, Ohnuma, Tetsu, MD, Itoh, Satoshi, MD, PhD, Sasabuchi, Yusuke, MD, Asaka, Kayo, MD, Shiotsuka, Junji, MD, Adachi, Koichi, MD, Yuri, Koich, MD, Matsumoto, Harunobu, MD, PhD, Yamaguchi, Atsushi, MD, PhD, Sanui, Masamitsu, MD, PhD, Adachi, Hideo, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Aneurysm, Dissecting - classification
Aneurysm, Dissecting - mortality
Aneurysm, Dissecting - surgery
Aortic Aneurysm, Thoracic - classification
Aortic Aneurysm, Thoracic - mortality
Aortic Aneurysm, Thoracic - surgery
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - methods
Cardiovascular
Coronary vessels
Female
Heart attacks
Hospital Mortality
Hospitals
Humans
Japan
Male
Middle Aged
Mortality
Postoperative period
Prognosis
Risk Assessment
Risk Factors
Treatment Outcome
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Summary:The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, January 1997 to January 2011, were divided into 4 groups per Penn class: Aa (no ischemia, n = 187), Ab (localized ischemia with branch malperfusion, n = 67), Ac (generalized ischemia with circulatory collapse, n = 46), and Abc (localized and generalized ischemia, n = 51). Early and late outcomes were compared between groups. In-hospital mortality was 3% (6 of 187) for Penn Aa, 6% (4 of 67) for Penn Ab, 17% (8 of 46) for Penn Ac, and 22% (11 of 51) for Penn Abc. Multivariate logistic regression analysis showed Penn classes Ac and Abc, operation time >6 hours, and entry in the descending thoracic aorta to be risk factors for in-hospital mortality. Incidences of neurologic, respiratory, and hepatic complications differed between groups. Five-year cumulative survival was 85% in the Penn Aa group, 74% in the Penn Ab group (p = 0.027 vs Penn Aa), 78% in the Penn Ac group, and 67% in the Penn Abc group (p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.11.017