Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.

Baylor Scott and White Health Dallas Texas

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department University Hospital Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

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

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

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Glenfield Hospital Leicester United Kingdom

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

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

Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany; German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

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

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

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

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland; Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

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

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

Division of Cardiac Surgery University of Verona Medical School Verona Italy

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland; Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland

Heart Center Turku University Hospital University of Turku Turku Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool United Kingdom

National Center for Global Health Istituto Superiore di Sanitá Rome Italy

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