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Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection.

Publication ,  Journal Article
Kimura, N; Ohnuma, T; Itoh, S; Sasabuchi, Y; Asaka, K; Shiotsuka, J; Adachi, K; Yuri, K; Matsumoto, H; Yamaguchi, A; Sanui, M; Adachi, H
Published in: Am J Cardiol
February 15, 2014

The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, January 1997 to January 2011, were divided into 4 groups per Penn class: Aa (no ischemia, n = 187), Ab (localized ischemia with branch malperfusion, n = 67), Ac (generalized ischemia with circulatory collapse, n = 46), and Abc (localized and generalized ischemia, n = 51). Early and late outcomes were compared between groups. In-hospital mortality was 3% (6 of 187) for Penn Aa, 6% (4 of 67) for Penn Ab, 17% (8 of 46) for Penn Ac, and 22% (11 of 51) for Penn Abc. Multivariate logistic regression analysis showed Penn classes Ac and Abc, operation time >6 hours, and entry in the descending thoracic aorta to be risk factors for in-hospital mortality. Incidences of neurologic, respiratory, and hepatic complications differed between groups. Five-year cumulative survival was 85% in the Penn Aa group, 74% in the Penn Ab group (p = 0.027 vs Penn Aa), 78% in the Penn Ac group, and 67% in the Penn Abc group (p <0.001 vs Penn Aa). In conclusion, morbidity and mortality are high in patients with generalized ischemia. The Penn classification appears to be a useful risk assessment system for AAAD, predictive of outcomes.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

February 15, 2014

Volume

113

Issue

4

Start / End Page

724 / 730

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Middle Aged
  • Male
  • Japan
  • Humans
  • Hospital Mortality
  • Female
 

Citation

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Kimura, N., Ohnuma, T., Itoh, S., Sasabuchi, Y., Asaka, K., Shiotsuka, J., … Adachi, H. (2014). Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol, 113(4), 724–730. https://doi.org/10.1016/j.amjcard.2013.11.017
Kimura, Naoyuki, Tetsu Ohnuma, Satoshi Itoh, Yusuke Sasabuchi, Kayo Asaka, Junji Shiotsuka, Koichi Adachi, et al. “Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection.Am J Cardiol 113, no. 4 (February 15, 2014): 724–30. https://doi.org/10.1016/j.amjcard.2013.11.017.
Kimura N, Ohnuma T, Itoh S, Sasabuchi Y, Asaka K, Shiotsuka J, et al. Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol. 2014 Feb 15;113(4):724–30.
Kimura, Naoyuki, et al. “Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection.Am J Cardiol, vol. 113, no. 4, Feb. 2014, pp. 724–30. Pubmed, doi:10.1016/j.amjcard.2013.11.017.
Kimura N, Ohnuma T, Itoh S, Sasabuchi Y, Asaka K, Shiotsuka J, Adachi K, Yuri K, Matsumoto H, Yamaguchi A, Sanui M, Adachi H. Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol. 2014 Feb 15;113(4):724–730.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

February 15, 2014

Volume

113

Issue

4

Start / End Page

724 / 730

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Middle Aged
  • Male
  • Japan
  • Humans
  • Hospital Mortality
  • Female