Is the Penn classification a valid method to predict in-hospital mortality and outcomes after surgery in acute type A aortic dissection patients?

Objective: The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. In the present study, it was evaluated the effectiveness of the Penn classification in predicting in-hospital mortality after surgery in acute type A aortic dissection patients. Methods: We evaluated 58 patients (42 men and 16 women; mean age 62,17 ± 10,6 years), underwent emergency surgery for acute type A aortic dissection between September 2003 and June 2010 in our Department. We investigated the correlation between the pre-operative malperfusion and in-hospital outcome after surgery. We used the Penn classification. Results: 28 patients (48 %) were Penn class Aa (absence of branch vessel malperfusion or circulatory collapse), 11 (19%) were Penn class Ab (branch vessel malperfusion with ischemia), 5 (9%) were Penn class Ac (circulatory collapse with or without cardiac involvement) and 14 (24%) were Penn class Abc (both branch vessel malperfusion and circulatory collapse). Patients with localized or generalized ischemia or both, Penn class non-Aa, were 30 (52%). In-hospital mortality was 24%. In-hospital mortality was significantly higher in Penn class Abc e Penn class non-Aa. Intensive unit care stay, hospital ward stay and overall hospital stay was longer in Penn class non-Aa vs Penn class Aa. De Bakey type I dissection and type II diabetes mellitus were associated with in-hospital mortality. Conclusion: Preoperative malperfusion is important for evaluation of patients with acute aortic type A dissection. The Penn classification is a simple and quick method to apply and predict in-hospital mortality and outcomes.