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J Thorac Cardiovasc Surg. 2015 Oct;150(4):824-31.e1-5. doi: 10.1016/j.jtcvs.2015.07.026. Epub 2015 Jul 14.

Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection.

Author information

1
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: petersonm@smh.ca.
2
Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
3
Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
4
Division of Cardiac Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
5
Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
6
Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
7
Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
8
Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
9
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
10
Division of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
11
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
12
Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
13
Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.

Abstract

OBJECTIVES:

The complexity of surgical treatment for acute type A dissection contributes to the variability in patient management. This study was designed to elucidate the contemporary practice preferences of cardiac surgeons regarding different phases of management of acute type A aortic dissection.

METHODS:

A 34-item questionnaire was distributed to all Canadian adult cardiac surgeons addressing the preoperative, intraoperative, and postoperative management of acute type A dissection. A total of 100 responses were obtained (82% of active surgeons in Canada). Outcomes were compared between high- and low-volume aortic surgeons.

RESULTS:

Seventy-six percent of respondents favored axillary artery cannulation. High-volume surgeons (>150 cases) were more likely to indicate a target lowest nasopharyngeal temperature more than 20 °C (53% vs 25%, P = .02). The majority of surgeons (65%) recommended using selective antegrade cerebral perfusion, with a significantly greater proportion for higher-volume aortic surgeons (P = .03). In addition, high-volume aortic surgeons were more likely to recommend aortic root replacement at smaller diameters (73% vs 55%, P = .02), to recommend more extensive distal aortic resection with routine open hemiarch anastomosis (85% vs 65%, P = .04), and to more commonly perform total arch reconstruction when needed (93% vs 77%, P = .04). In the follow-up period, frequency of serial imaging of the residual aorta was significantly higher for high-volume aortic surgeons (P = .04).

CONCLUSIONS:

This study identified some commonalities in practice preferences among Canadian cardiac surgeons for the management of acute type A aortic dissection. However, it also highlighted significant differences in temperature management, cerebral protection strategies, and extent of resection between high-volume and low-volume aortic surgeons.

KEYWORDS:

aortic dissection; cerebral perfusion; hypothermic circulatory arrest; survey

Comment in

PMID:
26277466
DOI:
10.1016/j.jtcvs.2015.07.026
[Indexed for MEDLINE]
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