1. Nimesh D. Desai MD PHD, Alberto Pochettino MD, Wilson Szeto MD, William Moser RN, Kanika Gupta BA, Patrick Moeller BA, Joseph E. Bavaria MD Hospital of the University of Pennsylvania

2.  Perioperative mortality of surgery for acute Type A Aortic Dissection(TAD) is reported to be over 25% in large registries.  We present a large, long-term experience with repair of TAD in high risk patients presenting with advanced age, hemodynamic compromise and malperfusion.

3.  Between 1993 and 2009, we performed 490 emergent repairs for acute TAD. 55.7% (273/490) of patients had at least one high risk feature:  High Risk Features: age>80, Malperfusion, hemodynamic compromise  Data was abstracted from a large prospective database with annual follow-up and death index linkage. Standard univariate, survival and regression methodologies were utilized

4. 64% of patients underwent aortic valve resuspension, 12% AVR with ascending replacement and 24% underwent root replacement. Distal anastomoses were performed open under circulatory arrest conditions with either retrograde or antegrade perfusion. 5% of patients had connective tissue disorders and another 7% were bicuspid.

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11.  Higher acuity patients with acute type A aortic dissection experience poorer outcomes.  However, in a wide variety of patients, repair can be performed with acceptable mortality. Investigation of strategies to mitigate the effect of malperfusion and late reoperation on the distal segment is warranted.