Contemporary Outcomes and Predictors of Adverse Events After Repair of Acute Type A Aortic Dissection: Report From an Aortic Center

Abstract

Background: This study evaluates short-term outcomes in patients undergoing surgery for acute Type A aortic dissection (ATAAD) at a specialized aortic referral center.

Methods: Between October 2019 and October 2022, 80 consecutive patients underwent surgery for ATAAD at Yale New Haven Hospital. The patients were categorized into three groups: Penn Class A (n = 27) without malperfusion, Penn Class B (n = 22) with localized malperfusion without circulatory shock, and Penn Class C (n = 31) with generalized malperfusion and shock. Statistical analysis was performed to assess differences in perioperative descriptive variables, operative outcomes, and survival across Penn classification groups.

Results: The mean age of patients was 65.2 ± 13.7 years, with 65% being male. Cerebral malperfusion was the predominant type (p < 0.001). The most common surgical procedures performed were ascending and hemiarch aortic replacement with aortic valve/root repair. Antegrade thoracic endovascular aortic repair (TEVAR) was more frequent in Penn Class B and Class C than in Penn Class A (50.0%, 41.9% vs. 14.8%, p = 0.02). Postoperative complications included pneumonia (23.8%), postoperative renal failure (48.8%), and unplanned reoperation (18.8%, mostly for bleeding). Postoperative strokes occurred in 10%, all but one with preoperative neurologic deficits; none in Penn Class A. Persistent neurologic deficits were more common in Penn Class C than Class B (19.4% vs. 9.1%, p = 0.049). Postoperative renal failure and dialysis were associated with both malperfusion groups. Penn Class C had higher postoperative pneumonia (38.7%, p = 0.04) and tracheostomy (35.5%, p = 0.003). Overall postoperative mortality was 10%, highest in Penn Class C (19.4%, p = 0.048). Three-year postdischarge survival rates showed no significant differences between the groups (log-rank, p = 0.57).

Conclusion: Emergent surgical repair was linked to excellent survival (90%) and resolution of neurological deficit in 80% of patients. Circulatory shock showed the strongest association with operative mortality, followed by visceral malperfusion. No significant postdischarge survival differences were observed, though follow-up was limited.