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.
Highlights
Acute Type A aortic dissection (ATAD) is a devastating vascular event with a high pre-hospital and perioperative mortality ranging from 16 to 28%,1,2 with a 1 to 2% hourly mortality rate.[3]
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
We aimed to evaluate perioperative and 2-year outcomes associated with ATAD surgery performed by aortic received August 30, 2018 accepted after revision February 22, 2019
Summary
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. Multivariable logistic regression and Cox proportional hazard models were fitted to evaluate associations between the surgeon experience, perioperative outcomes, and survival, respectively. 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 1⁄4 0.2). Conclusion Operation by AS for ATAD was associated with reduced adjusted risk of 2year mortality. This adds support for establishing thoracic aortic emergency call teams staffed by AS
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