Acute Type A Aortic Dissection Surgery Performed by Aortic Specialists Improves 2-Year Outcomes

Abstract

Objective In patients presenting with acute Type A aortic dissections (ATADs), the authors sought to evaluate whether emergent aortic operations performed by cardiac surgeons with different level of aortic surgery experience can impact perioperative outcomes and survival.

Methods A single-center review of 102 patients who underwent aortic surgeries for ATAD was conducted. The cohort was divided into those operated on by aortic specialists (AS:3 surgeons) and non-AS (5 surgeons). Multivariable logistic regression and Cox proportional hazard models were fitted to evaluate associations between the surgeon experience, perioperative outcomes, and survival, respectively.

Results Of 102 patients, 60 were operated on by AS and 42 were operated on by non-AS. Overall 30-day mortality was 11 (10.8%) with 4 (6.6%) perioperative deaths in the AS group and 7 (16.6%) among the non-AS group (p = 0.2). AS performed a significantly higher number of root replacement procedures (41.6% vs. 23.8%, respectively, p = 0.049) and employed more frequent adjunct cerebral perfusion during circulatory arrest (p = 0.003). Survival analysis indicated AS status was an independent predictor of improved 2-year survival (hazard ratio: 0.37, 95% confidence interval: 0.15–0.92, p = 0.03).

Conclusion Operation by AS for ATAD was associated with reduced adjusted risk of 2-year mortality. This adds support for establishing thoracic aortic emergency call teams staffed by AS.

Keywords

ascending aortic surgery - acute Type A dissection - surgeon specialization

Note

IRB protocol ID: 2000021950; approval date: 10/23/2017. Read at the AATS aortic symposium 2018 (presentation on demand).

• References

• 1 Chikwe J, Cavallaro P, Itagaki S, Seigerman M, Diluozzo G, Adams DH. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality. Ann Thorac Surg 2013; 95 (05) 1563-1569
• 2 Trimarchi S, Nienaber CA, Rampoldi V. , et al; International Registry of Acute Aortic Dissection Investigators. Contemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005; 129 (01) 112-122
• 3 Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003; 108 (05) 628-635
• 4 Geirsson A, Ahlsson A, Franco-Cereceda A. , et al. Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection. Eur J Cardiothorac Surg 2018; 53 (01) 276-281
• 5 Lenos A, Bougioukakis P, Irimie V, Zacher M, Diegeler A, Urbanski PP. Impact of surgical experience on outcome in surgery of acute type A aortic dissection. Eur J Cardiothorac Surg 2015; 48 (03) 491-496
• 6 Vitale J, Manfredini R, Gallerani M. , et al. Chronobiology of acute aortic rupture or dissection: a systematic review and a meta-analysis of the literature. Chronobiol Int 2015; 32 (03) 385-394
• 7 Andersen ND, Benrashid E, Ross AK. , et al. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg 2016; 5 (03) 194-201
• 8 Achneck HE, Rizzo JA, Tranquilli M, Elefteriades JA. Safety of thoracic aortic surgery in the present era. Ann Thorac Surg 2007; 84 (04) 1180-1185 , discussion 1185
• 9 Peterss S, Charilaou P, Ziganshin BA, Elefteriades JA. Assessment of survival in retrospective studies: the Social Security Death Index is not adequate for estimation. J Thorac Cardiovasc Surg 2017; 153 (04) 899-901
• 10 Bashir M, Harky A, Fok M. , et al. Acute type A aortic dissection in the United Kingdom: surgeon volume-outcome relation. J Thorac Cardiovasc Surg 2017; 154 (02) 398-406.e1
• 11 Narayan P, Caputo M, Rogers CA. , et al. Early and mid-term outcomes of surgery of the ascending aorta/arch: is there a relationship with caseload?. Eur J Cardiothorac Surg 2004; 25 (05) 676-682
• 12 Hughes GC, Zhao Y, Rankin JS. , et al. Effects of institutional volumes on operative outcomes for aortic root replacement in North America. J Thorac Cardiovasc Surg 2013; 145 (01) 166-170
• 13 Bin Mahmood SU, Ulrich A, Safdar B, Geirsson A, Mangi AA. Spontaneous rupture of the ascending aorta. J Card Surg 2018; 33 (02) 107-114