• Michael Tien, Andrew Ku, Natalia Martinez-Acero, Jessica Zvara, Eric C Sun, and Albert T Cheung.
• Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
• J. Cardiothorac. Vasc. Anesth. 2020 Apr 1; 34 (4): 867873867-873.

ObjectivesMortality in acute aortic dissection varies depending on anatomic location, extent, and associated complications. The Stanford classification guides surgical versus medical management. The Penn classification stratifies mortality risk in patients with Stanford type A aortic dissections undergoing surgery. The objective of the present study was to determine whether the Penn classification can predict hospital mortality in patients with acute Stanford type A and type B aortic dissections undergoing surgical or medical management.DesignRetrospective, observational study.SettingTertiary care, university hospital.ParticipantsPatients with acute aortic dissection between January 2008 and December 2017.InterventionsExamination of hospital mortality after surgical or medical management.Measurements And Main ResultsThree hundred fifty-two patients had confirmed dissections (186 type A, 166 type B). The overall mortality was 18.8% for type A and 13.3% for type B. Penn class A patients with type A or type B dissections undergoing surgical repair had the lowest mortality (both 3.1%). Penn class B, C, or B+C patients with type A dissections and Penn class B+C patients with type B dissections undergoing medical management had the greatest incidence of mortality (50.0%-57.1%). All others had intermediate mortality (6.7%-39.3%). Logistic regression analysis demonstrated that Penn class B, C, and B+C patients had a greater odds of mortality and predicted mortality than did Penn class A patients.ConclusionsThe Penn classification predicts hospital mortality in patients with acute Stanford type A or type B aortic dissections undergoing surgical or medical management. Early endovascular repair may confer lower risk of mortality in patients with type B dissections presenting without ischemia.Copyright © 2019 Elsevier Inc. All rights reserved.

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