Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes

Objectives: The Stanford classification helps rapidly triage patients with type A acute aortic syndrome, but it overlooks key elements like proximal entry tear and malperfusion. The newer type, entry, malperfusion classification addresses these gaps to improve management. Methods: We conducted a retrospective monocentric study of all patients operated for type A acute aortic syndrome between 2010 and 2023. Results: Among 334 included patients, hospital mortality was 16.5%. Entry tear was located in the ascending aorta in 69%, the arch in 19%, and the descending aorta in 3.6%. Malperfusion occurred in 75% of patients; 35% had at least 1 clinical malperfusion. Arch or distal entry tears were significantly associated with more extensive arch resections. Coronary malperfusion led to more associated procedures (coronary artery bypass grafting, reimplantation), more frequent root replacements (M1-), and greater extracorporeal life support use (M1+). Clinical malperfusions were associated with greater mortality and complication rates. Patients who were M3+ displayed the most severe multiorgan complications. Conclusions: The type, entry, malperfusion classification offers valuable preoperative insights, helping to anticipate surgical strategy and identify high-risk patients. However, its ability to differentiate malperfusion severity remains limited.