Mortality in acute type A aortic dissection – A systematic review based on contemporary registries

Matei, Diana-Cristina; Robu, Cornel; Ciobanu, Celia Georgiana; Geavlete, Oliviana Dana; Antohi, Elena-Laura; Radu, RăZvan Ilie; Bubenek, Șerban; Iliescu, Vlad Anton; Chioncel, Ovidiu

doi:10.2478/rjim-2025-0015

Figures & Tables

Flowchart of the Identification and Selection of Studies Reporting Mortality in Acute Type A Aortic Dissection

Forest Plot of In-Hospital Mortality in Acute Type A Aortic Dissection: A Synthesis of Multicenter Registry Data

Forest Plot of 30-Day Mortality in Acute Type A Aortic Dissection: A Synthesis of Multicenter Registry Data

Forest Plot of Operative Mortality in Acute Type A Aortic Dissection: A Synthesis of Multicenter Registry Data

Risk of Bias Assessment Across Included Registries

Registry / Study	Clearly Defined Inclusion Criteria	Standardized Outcome Definitions	National or Multicentre Scope	Consecutive Case Inclusion	Completeness of Data Reported	Risk of Selection Bias
IRAD [4,6]	✓	✓	Multicentre	✓	✓	Moderate
GERAADA [7]	✓	✓	Multicentre	✓	✓	Low
ERTAAD [15]	✓	✓	Multicentre	✓	✓	Moderate
NORCAAD [8]	✓	✓	Multicentre	✓	✓	Moderate
STS Adult Cardiac Surgery Database [16]	✓	✓	National	✓	✓	Low
Australian and New Zealand SCTS [13]	✓	✓	National	✓	✓	Low
UK Aortic Group [12]	✓	✓	National	✓	✓	Low
Dutch Nationwide Registry [10]	✓	✓	National	✓	✓	Moderate
RENADA-RO [25]	✓	✓	National	✓	✓	Moderate
Danish National Registry [11]	✓	✓	National	✓	✓	Moderate
Nationwide German Diagnosis-Related Group Statistics [21]	✓	✓	National	✗	✗	Moderate
National Inpatient Sample [18]	✓	✓	National	✗	✗	Moderate
JRAD [22]	✓	✓	National	✓	✓	Low
JROAD-DPC [20]	✓	✓	National	✓	✓	Low
Japan Cardiovascular Surgery Database [17]	✓	✓	National	✓	✓	Low
China Registry [24]	✓	✓	National	✓	✓	Moderate
Sino-RAD [23]	✓	✓	National	✓	✓	Moderate

Preoperative Risk Factors Reported Across Registries

Study	Malperfusion	Cardiogenic shock	Reduced LVEF	PCS	Surgical Mortality
IRAD Evangelista et al. [6]	30%	15%	Not reported	14.2%	in-hospital 21%
GERAADA Conzelmann et al. [7]	33.6%	57.8%	Not reported	Not reported	30-day 16.9%
ERTAAD Biancari et al. [15]	Cerebral: 22.9% Renal: 10% Peripheral: 14.2% Mesenteric: 4.8% Spinal: 2.0%	43.6%	Not reported	3.6%	in-hospital 18.2%
NORCAAD Nozohoor et al. [9]	33.9%	21.4%	Not reported	Not reported	in-hospital 16%
Dutch nationwide registry study Timmermans et al. [10]	Not reported	30%	Not reported	5.2%	in-hospital 17%
UK Aortic Group Benedetto et al. [12]	36.5%	14.5%	20.4%	6%	in-hospital 17.8%
STS Adult Cardiac Surgery Database Lee et al. [16]	Not reported	15.8%	Not reported	Not included	operative 17.4%
Japan Cardiovascular Surgery Database Abe et al. [17]	Not reported	15.5%	28.1%	1.2%	operative 9.5%
JRAD Inoue et al. [22]	Not reported	19.5%	Not reported	16.3%	in-hospital 10.8%
China Registry of Type A Aortic Dissection Zhao et al. [24]	13.9%	3.9%	Not reported	4.2%	in-hospital 7.6%

Mortality Outcomes and Demographic Profiles Across Major ATAAD Registries

Study	N	Years	Age	Female Gender	Surgical Mortality	Medically Managed / Mortality
IRAD Harris et al. [4]	5611	1996 – 2018	60.4± 14.1	32.9%	48h 4.4%	8.6 % / 23.7%
IRAD Evangelista et al. [6]	2952	1996 – 2016			in-hospital 25% → 18%^*	14% / 57%
ERTAAD Biancari et al. [15]	2477	2005 – 2021	63.5± 13.1	31%	in-hospital 18.2%
NORCAAD Nozohoor et al. [9]	1159	2005 – 2014	61.5 ± 12.1	32.4%	in-hospital 16%
GERAADA Conzelmann et al. [7]	2137	2006 – 2010	60.5± 13.6	38.3%	30-day 16.9%
Nationwide German Diagnosis-Related Group Statistics Reutersberg et al. [21]	14911	2006 – 2014	64 ± 9	35%	in-hospital 19.5%
Danish National Registry Pedersen et al. [19]	1157	2006 – 2015	66 [57–74]	35.4%	in-hospital 18%	26% / 52%
Danish National Registry Obel et al. [11]	1620	1996 – 2016	63.5 ± 12.9	32.5%	30-day 22%
Dutch nationwide registry study Timmermans et al. [10]	1317	2018 – 2021	63.1 ± 11.8	41%	in-hospital 20.4% → 13.9%
Dutch nationwide registry study Timmermans et al. [10]	1317	2018 – 2021	63.1 ± 11.8	41%	30-day 17.2%
RENADA-RO Matei et al. [25]	501	2011 – 2022	60 ± 11	35%	in-hospital 29%
UK National Adult Cardiac Surgical Audit Benedetto et al. [12]	4203	2009 – 2018	64 [52–73]	33.3%	in-hospital 17.8%
National Inpatient Sample Catalano et al. [18]	7805	2017 – 2018	60.0 ± 13.6	34%	in-hospital 15.3%
STS Adult Cardiac Surgery Database Lee et al. [16]	2982	2011 – 2012	59.7 ± 14.0	34.4%	operative 17.4%
Japan Cardiovascular Surgery Database Abe et al. [17]	11843	2008 – 2015	69 [60–77]	51.8%	operative9.5%
Japan Cardiovascular Surgery Database Abe et al. [17]	11843	2008 – 2015	69 [60–77]	51.8%	30-day 7.6%
JRAD Inoue et al. [22]	1217	2011 – 2016	67.9 ± 13.1	52.1%	in-hospital 10.8%	24.8% / 16.6%
JROAD-DPC Yamaguchi et al. [20]	10131	2012 – 2015	69.8 ± 13.5	53.1%	in-hospital 11.8%	33% / 49.7%
China Registry of Type A Aortic Dissection Zhao et al. [24]	1058	2018 – 2021	51.6 ± 11.7	23.8%	in-hospital 7.6%
Sino-RAD Duan et al. [23]	1582	2012 – 2016	48.9 ± 11.1	21.7%	in-hospital 5.5%	7.8% / not mentioned
Australian and New Zealand SCTS Knox et al. [13]	2604	2001 – 2021	65 [54–74]	33%	30-day 18%

Methodological Characteristics of Contemporary ATAAD Registries

Study	Region	Study Type	Data Source	Included
IRAD Harris et al. [4] Evangelista et al. [6]	14 countries	retrospective analysis of prospectively collected data	standardized case report forms (350 variables)	AAD – tertiary referral centres
ERTAAD Biancari et al. [14,15]	8 european countries	retrospective analysis of prospectively collected data	standardized case report forms	Surgically treated ATAAD – referral centres
NORCAAD Geirsson et al.[8] Nozohoor et al.[9]	Denmark, Finland, Iceland, Sweden	retrospective analysis of prospectively collected data	standardized case report forms (194 variables)	Surgically treated ATAAD – referral centres
GERAADA Conzelmann et al. [7]	Austria, Switzerland, Germany	prospective	standardized case report forms (90 parameters)	Surgically treated ATAAD
Nationwide German Diagnosis-Related Group Statistics Reutersberg et al. [21]	Germany	retrospective	ICD-10 codes & other codes	Surgically treated AAD – nationwide coverage
Danish National Registry Pedersen et al. [19] Obel et al. [11]	Denmark	retrospective	ICD-10 codes & other codes (linked 4 different registries)	Acute Aortic Dissection – nationwide coverage
Dutch nationwide registry Timmermans et al. [10]	Netherlands	retrospective analysis of prospectively collected data	standardized case report forms + mortality data via ICD-10 codes	Surgically treated AAD – nationwide coverage
RENADA-RO Matei et al. [25]	Romania	retrospective analysis of prospectively collected data	standardized case report forms	ATAAD – referral centres
UK National Adult Cardiac Surgical Audit Benedetto et al. [12]	UK	retrospective analysis of prospectively collected data	standardized case report forms	Surgically treated ATAAD – referral centres
National Inpatient Sample Catalano et al. [18]	USA	retrospective	ICD-10 codes	Surgically treated ATAAD – nationwide coverage
STS Adult Cardiac Surgery Database Lee et al. [16]	USA	retrospective analysis of prospectively collected data	standardized case report forms (>260 variables)	Surgically treated ATAAD – nationwide coverage
Japan Cardiovascular Surgery Database Abe et al. [17]	Japan	retrospective analysis of prospectively collected data	standardized case report forms (255 variables)	Surgically treated AAD – nationwide coverage
JRAD Inoue et al. [22]	Japan	retrospective	standardized case report forms (162 variables)	AAD – referral centres
JROAD-DPC Yamaguchi et al. [20]	Japan	retrospective	ICD-10 codes	AAD – nationwide coverage
China Registry of Type A Aortic Dissection Zhao et al. [24]	China	retrospective analysis of prospectively collected data	standardized case report forms	Surgically treated ATAAD – referral centres
Sino-RAD Duan et al. [23]	China	retrospective analysis of prospectively and retrospectively collected data	standardized case report forms	ATAAD and ATAIMH – referral centres
ANZSCTS Knox et al. [13]	Australia and New Zealand	retrospective	standardized case report forms	Surgically treated ATAAD

Mortality in acute type A aortic dissection – A systematic review based on contemporary registries

Figures & Tables

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Risk of Bias Assessment Across Included Registries

Preoperative Risk Factors Reported Across Registries

Mortality Outcomes and Demographic Profiles Across Major ATAAD Registries

Methodological Characteristics of Contemporary ATAAD Registries

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