The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume thoracic aortic surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair.
Background
Outcomes of ATAAD repair may be improved when operations are performed at specialized high-volume thoracic aortic surgical centers.
Methods
Between 1999 and 2011, 128 patients underwent ATAAD repair at our institution. Records of patients who underwent ATAAD repair 6 years before (n = 56) and 6 years after (n = 72) implementation of the TASP were retrospectively compared. Expected operative mortality rates were calculated using the International Registry of Acute Aortic Dissection pre-operative prediction model.
Results
Baseline risk profiles and expected operative mortality rates were comparable between patients who underwent surgery before and after implementation of the TASP. Operative mortality before TASP implementation was 33.9% and was statistically equivalent to the expected operative mortality rate of 26.0% (observed-to-expected mortality ratio 1.30; p = 0.54). Operative mortality after TASP implementation fell to 2.8% and was statistically improved compared with the expected operative mortality rate of 18.2% (observed-to-expected mortality ratio 0.15; p = 0.005). Differences in survival persisted over long-term follow-up, with 5-year survival rates of 85% observed for TASP patients compared with 55% for pre-TASP patients (p = 0.002).
Conclusions
ATAAD repair can be performed with results approximating those of elective proximal aortic surgery when operations are performed by a high-volume multidisciplinary thoracic aortic surgery team. Efforts to standardize or centralize care of patients undergoing ATAAD are warranted.
Key Words
aortic dissection
aortic surgery
outcomes
Abbreviations and Acronyms
ATAAD
acute type A aortic dissection repair
CPB
cardiopulmonary bypass
IRAD
International Registry of Acute Aortic Dissection
NIS
Nationwide Inpatient Sample
rFVIIa
recombinant activated factor VII
TASP
thoracic aortic surgery program
Cited by (0)
Dr. Andersen was supported by a Thoracic Surgery Foundation for Research and Education Research Fellowship. Dr. Williams was supported by National Institutes of Health grant U01-HL088953. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
