title: Generalized ischaemia in type A aortic dissections predicts early surgical outcomes only.
abstract: OBJECTIVE
  In patients with acute type A aortic dissection (aTAAD), early post-surgical outcomes are largely influenced by preoperative conditions, specifically localized or generalized ischaemia. Such states are reflected in the recent Penn classification. Our aim was to determine the impact of preoperative ischaemia (by Penn class) on in-hospital and long-term mortality.
  
  
  METHODS
  All consecutive patients (n = 341) surgically treated for aTAAD between 1998 and 2014 were recruited for a retrospective observational study. Parameters impacting in-hospital and long-term mortality were identified through univariable and multivariable analyses.
  
  
  RESULTS
  In-hospital mortality rates by Penn class were as follows: Class Aa, 11%; Class Ab, 14%; Class Ac, 42% and Class Abc, 29%. Both Ac [odds ratio (OR) = 4.4; 95% confidence interval (CI), 1.92-9.80] and Abc (OR = 3.72; 95% CI, 1.26-10.99) classifications independently predicted in-hospital mortality, as did cardiopulmonary bypass time (OR = 1.01; 95% CI, 1.00-1.01). Relative to Class Aa patients, survival did not differ significantly in Class Ac and Abc subsets (log-rank P = 0.365 and P = 0.716, respectively), once 30-day postoperative deaths were excluded. The leading cause of late mortality was cardiac failure or myocardial infarction (29%), followed by aortic rupture (25%). Independent predictors of long-term mortality after aTAAD were age [hazard ratio (HR) = 1.08; 95% CI, 1.05-1.10] and supracoronary replacement graft (HR = 2.27; 95% CI, 1.1-4.75).
  
  
  CONCLUSIONS
  Penn classes Ac and Abc were identified as an independent risk factor for in-hospital mortality, whereas neither Penn class nor organ-specific ischaemia significantly impacted long-term survival. Regardless of ischaemic manifestations at presentation, the prognosis of patients surviving both surgery and early postoperative period proved acceptable.
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesiology and Intensive Care, Lund University and Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Eric
authors.initials: E
authors.lastname: Danielsson
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesiology and Intensive Care, Lund University and Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Igor
authors.initials: I
authors.lastname: Zindovic
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesiology and Intensive Care, Lund University and Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesiology and Intensive Care, Lund University and Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Ingemansson
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesiology and Intensive Care, Lund University and Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Cardiothoracic Surgery, Lund, Sweden shahab.nozohoor@med.lu.se.
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Aortic dissection; Multiorgan ischaemia; Outcomes