Operative Strategies and Outcomes in Type A Aortic Dissection After the Enactment of a Multidisciplinary Aortic Surgery Team

• Published in: Innovations (Philadelphia, Pa.) Pa.), 2015-11, Vol.10 (6), p.410-415
• Main Authors: Beller, Jared P, Scheinerman, Joshua A, Balsam, Leora B, Ursomanno, Patricia, DeAnda, Jr, Abe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Female; Humans; Interdisciplinary Communication; Male; Middle Aged; Mortality; New York - epidemiology; Registries; Retrospective Studies; Surgical Procedures, Operative - methods; Surgical Procedures, Operative - standards; Survival Analysis; Treatment Outcome
• ISSN: 1556-9845; 1559-0879
• DOI: 10.1097/imi.0000000000000212

The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery team. Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005-2009, N = 39) and after (2010-2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.