1638 Decade-Long Trends in Surgery for Acute Type A Aortic Dissection

Abstract Background Little is known about unwarranted variations in care and outcomes of patients who undergo surgical repair for type A acute aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England. Method Retrospective review of the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit (NACSA) registry from January 2009 to December 2018 , which prospectively collects demographic and peri-operative clinical information for all adult cardiac surgery procedures in the UK. Results Over the 10-year period,3,686 TAAD patients underwent surgical repair in England. A steady doubling in the overall number of operations conducted in England was observed from 237 cases recorded in 2009 to 510 in 2018. Number of procedures per hospital per year also doubled, from 10 in 2009 to 21 in 2018. The risk profile of the operated patients remained unchanged. Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in the most recent years (from 22.8% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality across regions with a trend towards lower mortality in regions with a high-volume hospital. Conclusions Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival following surgery has improved. Regional variations exist in service provision with a trend towards better survival in high volume centers.

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Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽

10.1161/circulationaha.118.038867 ◽

2019 ◽

Vol 140 (15) ◽

pp. 1239-1250 ◽

Cited By ~ 12

Author(s):

Andrew B. Goldstone ◽

Peter Chiu ◽

Michael Baiocchi ◽

Bharathi Lingala ◽

Justin Lee ◽

...

Keyword(s):

Aortic Dissection ◽

Operative Mortality ◽

Type A ◽

High Volume ◽

The United States ◽

Acute Type ◽

Medicare Beneficiaries ◽

Type A Aortic Dissection ◽

High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

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Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database

Journal of Cardiac Surgery ◽

10.1111/jocs.13511 ◽

2018 ◽

Vol 33 (1) ◽

pp. 7-18 ◽

Cited By ~ 37

Author(s):

Teng C. Lee ◽

Zachary Kon ◽

Faisal H. Cheema ◽

Maria V. Grau-Sepulveda ◽

Brian Englum ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Contemporary Management ◽

Adult Cardiac Surgery

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Results following surgical repair of acute type A aortic dissection (AAAD): A single centre experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269332 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

P Benedikt ◽

L Bartl ◽

P Hartl ◽

C Schwarz

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Single Centre ◽

Type A Aortic Dissection ◽

Single Centre Experience

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Trends and Risk Factors for Stroke and Mortality following Surgical Repair of acute Type A Aortic Dissection: A Single-Center Experience Over 15 Years

10.1055/s-0040-1705513 ◽

2020 ◽

Author(s):

F. Pollari ◽

S. Pfeiffer ◽

C. Eckrich ◽

J. Sirch ◽

T. Fischlein

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Single Center ◽

Type A Aortic Dissection ◽

Single Center Experience

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Risk factors for hypoxemia following surgical repair of acute type A aortic dissection

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw272 ◽

2016 ◽

pp. ivw272

Author(s):

Nan Liu ◽

Wei Zhang ◽

Weiguo Ma ◽

Wei Shang ◽

Jun Zheng ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Aorta ◽

10.1055/s-0039-1687900 ◽

2019 ◽

Vol 07 (01) ◽

pp. 007-014

Author(s):

Raphaelle A. Chemtob ◽

Vibeke Hjortdal ◽

Anders Ahlsson ◽

Jarmo Gunn ◽

Ari Mennander ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Multivariable Analysis ◽

Operation Time ◽

Postoperative Outcome ◽

Type A ◽

Operative Management ◽

Chronic Obstructive ◽

Acute Type ◽

Type A Aortic Dissection

Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD. Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69). Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

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