January 14, 2026Interdisciplinary CardioVascular and Thoracic Surgery0 citationsOpen Access

A TEM-based propensity score matched analysis depending on surgical expertise in patients without malperfusion undergoing surgery for acute type A aortic dissection

LPLeonard Pitts LHLina Hülsenberg MMMatteo Montagner

Key Result

Patients without preoperative malperfusion show no differences in thirty-day mortality or stroke between aortic and non-aortic surgeons (26% vs 23%, p = 0.54).

Key Points

Investigate short- and midterm outcomes in patients without malperfusion undergoing surgery for acute type A aortic dissection based on surgeon expertise.
Included patients undergoing surgery for acute type A aortic dissection from 2013 to 2023.
Divided patients into aortic surgeon vs. non-aortic surgeon groups based on surgeon expertise.
Used propensity score matching to balance groups before comparison of intraoperative variables and outcomes.
There were no significant differences in cardiopulmonary bypass, cross-clamp, and distal arrest times.
Aortic surgeons performed more extensive procedures with significant differences for root replacements and frozen elephant trunk implantation.
The combined thirty-day mortality and stroke rate was similar: 26% non-aortic vs. 23% aortic surgeons (p = 0.54).
No significant differences in five-year survival rates were found (p = 0.170).

Structured PICO

Does surgery performed by a specialized aortic surgeon improve short- and midterm outcomes in patients without malperfusion undergoing surgery for acute type A aortic dissection compared to non-aortic surgeons?

Population

234 propensity-matched patients without malperfusion (M0 according to the Type-Entry-Malperfusion classification) undergoing surgery for acute type A aortic dissection between 2013-2023.

Intervention

Surgery performed by a specialized aortic surgeon (defined by expertise in extensive aortic arch surgery including frozen elephant trunk implantation on a regular basis, average ≥5/year).

Comparator

Surgery performed by a non-aortic surgeon.

Outcome

Combined end-point consisting of thirty-day mortality and/or CT-confirmed stroke.composite

In patients with acute type A aortic dissection without malperfusion, short- and midterm outcomes are similar whether the surgery is performed by specialized aortic surgeons or non-aortic surgeons, although specialized surgeons safely perform more extensive aortic repairs.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract OBJECTIVES This study investigates differences in short- and midterm outcomes in patients without malperfusion undergoing surgery for acute type A aortic dissection between specialized aortic surgeons and non-aortic surgeons. METHODS Patients who underwent surgery for acute type A aortic dissection between 2013–2023 defined as M0 (no malperfusion) according to the Type-Entry-Malperfusion classification were included and divided into two groups according to the surgeon’s expertise: aortic surgeon versus non-aortic surgeon group, whereas an aortic surgeon was defined by expertise in extensive aortic arch surgery including frozen elephant trunk implantation on a regular basis (average ≥5/year). After propensity score matching, the groups were compared in terms of intraoperative variables and outcomes including a primary combined end-point consisting of thirty-day mortality and/or CT-confirmed stroke. RESULTS The matched cohort comprised two balanced groups with 234 patients (117 each group). Cardiopulmonary bypass, cross-clamp and distal arrest times did not differ significantly between the groups. However, more extensive aortic surgery was performed by aortic surgeons: aortic root replacement (Bentall) (p = 0.007; OR 1.18 (CI 1.05–1.32)), valve-sparing root replacement (David) (p = 0.013; OR 1.05 (CI 1.01–1.10)) and frozen elephant trunk implantation (p 0.001; OR 1.18 (CI 1.09–1.27)). The combined end-point of thirty-day mortality and/or CT-confirmed stroke was 26% in the non-aortic surgeon vs 23% in the aortic surgeon group (p = 0.54; OR 0.97 (CI 0.86–1.08)). Further clinical outcomes, including five-year survival, did not differ significantly (p = 0.170). CONCLUSIONS Patients without preoperative malperfusion undergoing surgery for ATAAD show no differences in terms of short- and midterm outcomes between specialized aortic and non-aortic surgeons. However, more extensive aortic repair may be performed safely by specialized aortic surgeons. These results support the definition of an aortic surgeon based on experience with the FET technique and may advocate call coverage by an aortic surgeon for type A repair at high-volume centers.

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