Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD)

Background: In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan. Methods: Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled. Results: Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01). Conclusions: JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.