Surgical repair of iATAAD remains associated with high mortality, especially when the dissection follows catheter-based procedures. The findings, published in The Annals of Thoracic Surgery, draw from The Society of Thoracic Surgeons Adult Cardiac Surgery Database spanning July 2017 to December 2023.

The analysis included 971 patients with iATAAD and 25,026 with spontaneous acute type A aortic dissection (sATAAD). Patients with iATAAD were typically older, more often female, and had higher rates of hypertension, heart failure, and preoperative anticoagulation. Operative mortality was significantly greater in iATAAD compared with sATAAD (31.9% vs 18.2%; P < .001). Mortality was particularly elevated following transcatheter aortic valve replacement (43%) and percutaneous coronary intervention (35%).

Reoperation for bleeding occurred more frequently in iATAAD cases (10.6% vs 8.1%; P = .007), while rates of stroke, renal failure, and 30-day readmission were comparable between groups. Independent predictors of mortality included older age, cardiogenic shock, abdominal malperfusion, and use of extracorporeal membrane oxygenation or intraaortic balloon pump.

These results emphasize the critical risk associated with iatrogenic dissections, emphasizing the need for prevention strategies and rapid recognition to improve surgical outcomes.