(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p < 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.

Cardiac Surgery Molinette Hospital University of Turin 10126 Turin Italy

Cardiothoracic Department University Hospital of Udine 33100 Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón 28007 Madrid Spain

Centre Hospitalier Annecy Genevois 74370 Annecy France

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady 10000 Prague Czech Republic

Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis 93200 Paris France

Department of Cardiac Surgery Glenfield Hospital Leicester LE3 9QP UK

Department of Cardiac Surgery Heart and Lung Center Helsinki University Hospital University of Helsinki 00029 Helsinki Finland

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris 94000 Creteil France

Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University 80539 Munich Germany

Department of Cardiac Surgery Ziekenhuis Oost Limburg 3600 Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster 48149 Muenster Germany

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona 08036 Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg 20251 Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki 53130 Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte 25030 Besancon France

Department of Vascular Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris 94000 Creteil France

Division of Cardiac Surgery Cardio Thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina 34148 Trieste Italy

Division of Cardiac Surgery Medical School University of Verona 37124 Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance 80539 Munich Germany

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool L14 3PE UK

Research Unit of Surgery Anesthesia and Critical Care University of Oulu 90570 Oulu Finland

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