Prognosis in acute aortic dissection. Insights from the International Registry of Acute Aortic Dissection

Abstract

<p><i>Background/aims:</i> Acute aortic dissection (AAD) is a rare life-threatening disease that does not easily lend itself to randomized controlled trials. Data regarding the effect of treatment advances in the recent decades is limited. Determinants of follow-up mortality are poorly understood. To include many patients and evaluate contemporary management of AAD, the International Registry of Acute Aortic Dissection (IRAD) was established in 1996. This work was undertaken to examine factors associated with morbidity and mortality after an AAD – specifically whether a partial thrombosis of the false lumen is a negative prognostic marker in type A AAD (AAAD), whether an open distal anastomosis confer prognostic benefit in AAAD surgery and finally whether the aortic arch should be resected at initial surgery for AAAD. Furthermore, we assessed the changes in management and outcomes of patients with AAAD over time.<p> <p><i>Methods:</i> Data collected in the IRAD since 1996 was used for analyzes. A literature search was done to evaluate the existing evidence for an open distal anastomosis in AAAD surgery.<p> <p><i>Results/conclusions:</i> A partial thrombosis of the false lumen was not associated with increased mortality, aortic growth or re-intervention in the follow-up period after an AAAD. Patients with an AAAD who survive the acute event have a favorable mid-term prognosis. Over time, a decrease in inhospital mortality was seen in AAAD, but not in type B AAD. More patients with AAD are managed with interventional procedures in the current era. An extended arch resection in AAAD has no discernable acute downside compared with less extensive surgery. Finally, based on the available literature, the data to support either an open or a closed distal anastomosis in AAAD is insufficient, and the surgical management of AAAD should be based in individual and aortic-specific assessment and take the patient’s age, comorbidities and preoperative clinical condition into account.<p>