Lesson learned from the International Registry of Acute Aortic Dissection (IRAD)

Acute aortic dissection (AAD) is a life-threatening disorder that is challenging to diagnose and with defined optimal therapies and outcomes. It is associated with high morbidity and mortality rates, in spite of new management approaches developed over the past few decades. In this article we review lessons learned from the 20-year IRAD Registry experience and its nearly 100 publications. The International Registry of Acute Aortic Dissection (IRAD) is an ongoing registry, which was established in 1996 with the aim to collect data and provide information on this rare disease in order to provide better decision making on clinical practice and surgical management. Acute aortic dissection, including intramural hematoma, is defined as onset of symptoms within 14 days to hospital admission. After 20 years of enrollment, more than 8000 patients with AAD have been collected worldwide, roughly two-thirds with type A and one-third with type B. Data shows trend for a reduced overall in hospital mortality over the years, in particular for those operated on for type A AAD, due to the improvement in operative technologies, organ perfusion and surgeons taking on even high-risk patients. In contrast, for type B AAD endovascular repair has been more frequently adopted in recent years but without a significant demonstrable reduction of in hospital mortality, although an increased survival rate at 5 years was observed. Data suggest an increase in surgical intervention treatment for both type A and B AAD, particularly in B due to expansion of endovascular treatment. While expanded surgical repair tbr type A has shown a trend for a better outcome, this was not observed for type B patients. In addition, debate continues about endovascular treatment of uncomplicated type B and IMH.