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 Scopus citations

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

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Keywords

  • Aortic dissection
  • Aortic surgery
  • Multidisciplinary team

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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