Evolution of diagnosis and clinical outcomes in acute aortic dissection: data from the International Registry of Acute Aortic Dissection

Acute aortic dissection (AAD) is a life-threatening condition with a dismal prognosis, results from an intimal tear in the aortic wall, allowing hematoma to form within the media of the aorta between the inner two-thirds and outer one-third of the aorta. In this situation, rupture into the pericardium, pleural cavity or mediastinum can easily occur, and it is almost impossible to save the patient’s life. Although the mortality rate remains high, it has been decreasing over the decades. According to the annual report from the Japanese Association of Thoracic Surgery, the operative mortality rate of 4,444 patients with Stanford type A AAD was 9.1% in 2013, a slight improvement compared with 2012 (10.6%) (1). For patients with Stanford type B AAD, thoracic endovascular aortic repair (TEVAR) has been increasingly undertaken, with improved outcomes. In Japan, in-hospital mortality rates associated with TEVAR in 2013 were 11.2% in acute cases and 2.2% in chronic cases. In addition, the number of TEVARs for Stanford type B cases increased from 77 in 2003 to 556 in 2013. These improvements in clinical outcomes originated from the public’s awareness of this life-threatening condition and more extensive use of advanced imaging modalities, especially computed tomography (CT) (2). The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 to enroll patients at major aortic centers worldwide. Using IRAD data, Pape et al. investigated the presentation, management and outcomes of AAD in 4,428 patients at 28 IRAD centers (2).