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J Am Coll Cardiol. 2014 May 6;63(17):1796-803. doi: 10.1016/j.jacc.2013.10.085. Epub 2014 Jan 8.

Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program.

Author information

1
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
2
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: gchad.hughes@duke.edu.

Abstract

OBJECTIVES:

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.

KEYWORDS:

aortic dissection; aortic surgery; outcomes

PMID:
24412454
PMCID:
PMC4159705
DOI:
10.1016/j.jacc.2013.10.085
[Indexed for MEDLINE]
Free PMC Article

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