Operative strategies and outcomes in type a aortic dissection after the enactment of a multidisciplinary aortic surgery team

Jared P. Beller, Joshua A. Scheinerman, Leora B. Balsam, Patricia Ursomanno, Abelardo DeAnda

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: 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. Methods: 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. Results: 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 G 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. Conclusions: Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

Original languageEnglish (US)
Pages (from-to)410-415
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume10
Issue number6
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Dissection
Registries
Mortality
Renal Insufficiency
Perfusion
Nurses
Demography

Keywords

  • Aortic dissection
  • Aortic surgery
  • Multidisciplinary team

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Operative strategies and outcomes in type a aortic dissection after the enactment of a multidisciplinary aortic surgery team. / Beller, Jared P.; Scheinerman, Joshua A.; Balsam, Leora B.; Ursomanno, Patricia; DeAnda, Abelardo.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 10, No. 6, 2015, p. 410-415.

Research output: Contribution to journalArticle

@article{1e12b23c480f4c6da713d54114bf7a8b,
title = "Operative strategies and outcomes in type a aortic dissection after the enactment of a multidisciplinary aortic surgery team",
abstract = "Objective: 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. Methods: 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. Results: 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 G 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. Conclusions: Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.",
keywords = "Aortic dissection, Aortic surgery, Multidisciplinary team",
author = "Beller, {Jared P.} and Scheinerman, {Joshua A.} and Balsam, {Leora B.} and Patricia Ursomanno and Abelardo DeAnda",
year = "2015",
doi = "10.1097/IMI.0000000000000212",
language = "English (US)",
volume = "10",
pages = "410--415",
journal = "Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery",
issn = "1556-9845",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Operative strategies and outcomes in type a aortic dissection after the enactment of a multidisciplinary aortic surgery team

AU - Beller, Jared P.

AU - Scheinerman, Joshua A.

AU - Balsam, Leora B.

AU - Ursomanno, Patricia

AU - DeAnda, Abelardo

PY - 2015

Y1 - 2015

N2 - Objective: 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. Methods: 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. Results: 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 G 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. Conclusions: Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

AB - Objective: 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. Methods: 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. Results: 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 G 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. Conclusions: Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

KW - Aortic dissection

KW - Aortic surgery

KW - Multidisciplinary team

UR - http://www.scopus.com/inward/record.url?scp=84953370086&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953370086&partnerID=8YFLogxK

U2 - 10.1097/IMI.0000000000000212

DO - 10.1097/IMI.0000000000000212

M3 - Article

C2 - 26680753

AN - SCOPUS:84953370086

VL - 10

SP - 410

EP - 415

JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

SN - 1556-9845

IS - 6

ER -