235 Acta Cardiol 2016; 71(2): 235-240 doi: 10.2143/AC.71.2.3141855 Address for correspondence: Dr. Calogera Pisano, Unit of Cardiac Surgery, Dept. of Surgery and Oncology, Liborio Giuffrè Street n. 5, 90100 Palermo, Italy. E-mail address: bacalipi@libero.it Received 14 March 2015; revision accepted for publication 20 July 2015. INTRODUCTION Acute aortic dissection type A (AADA) is an emer- gency situation in cardiac surgery associated with high- risk mortality due to aortic rupture or malperfusion 1 . A commonly accepted principle is that the treatment of acute AADA is immediate surgical proximal aortic repair, due to the high mortality rate associated with time delay. Prompt surgical therapy lowers the mortality from 55% during the first 14 days to 20% after surgery 2-8 . Penn classifcation in acute aortic dissection patients Calogera PISANO 1 , MD; Carmela Rita BALISTRERI 2 , PhD; Federico TORRETTA 3 , PhD; Veronica CAPUCCIO 3 , PhD; Alberto ALLEGRA 1 , MD; Vincenzo ARGANO 1 , MD; Giovanni RUVOLO 1 , MD 1 Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Italy; 2 Immunosenescence Group, Department of Pathobiology and Medical and Forensic Biotechnologies, University of Palermo, Italy; 3 Statistic Department, University of Palermo, Italy. *Tese authors contributed equally to this study Objective The objective of this study was to evaluate the efectiveness of the Penn classifcation in predicting in-hospital mortality after surgery in acute type A aortic dissection patients. Methods We evaluated 58 patients (42 men and 16 women; mean age 62.17 ± 10.6 years) who underwent emergency surgery for acute type A aortic dissection between September 2003 and June 2010 in our department. We investigated the correlation between the pre-operative malperfusion and in-hospital outcome after surgery. Results Twenty-eight patients (48%) were Penn class Aa (absence of branch vessel malperfusion or circulatory collapse), 11 (19%) were Penn class Ab (branch vessel malperfusion with ischaemia), 5 (9%) were Penn class Ac (circulatory collapse with or without cardiac involvement) and 14 (24%) were Penn class Abc (both branch vessel malperfusion and circulatory collapse). The number of patients with localized or generalized ischaemia or both, Penn class non-Aa, was 30 (52%). In-hospital mortality was 24%. In-hospital mortality was signifcantly higher in Penn class Abc and Penn class non-Aa. Intensive unit care stay, hospital ward stay and overall hospital stay was longer in Penn class non-Aa vs Penn class Aa. De Bakey type I dissection and type II diabetes mellitus were associated with in-hospital mortality. Conclusion Preoperative malperfusion is important for the evaluation of patients with acute aortic type A dissection. The Penn classifcation is a simple and quick method to apply and predict in-hospital mortality and outcomes. Keywords Type A dissection – Stanford classification – DeBakey classification – Penn classification. The AADA clinical presentation is one of the most important risk factors for in-hospital mortality and out- come. Several recent reports highlight the crucial role of preoperative malperfusion and ischaemia, localized or generalized as in shock, as predictors of adverse sur- gical outcome 9-12 . Specifically, the Penn classification of acute aortic dissection, based on preoperative ischaemic conditions, has recently been described 13,18 . The present study aims to evaluate the efficiency of the Penn classification in predicting in-hospital mortality and outcomes in a cohort of consecutive patients operated for AADA. SUBJECTS AND METHODS Our study received the approval from the local ethics committees. The need for individual informed consent was waived. Data were encoded to ensure patient and [ Original article ]