Key points are not available for this paper at this time.
OBJECTIVES: Acute Type A aortic dissection (ATAAD) repair is a high-risk procedure with significant in-hospital mortality. This study evaluates the impact of implementing an On-call Specialist Aortic Rota on ATAAD repair outcomes. METHODS: Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n = 406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups. RESULTS: Preoperative characteristics were similar between groups (mean age 59.7 ± 14 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P = .049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P = .033). Group B had a higher rate of aortic root replacement (44% vs 35%, P = .008), lower ascending aorta and hemiarch replacement (40% vs 53%, P = .013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P = .139) and frozen elephant trunk (20% vs 14%, P = .171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P = .250) and continuous renal replacement therapy (9.8% vs 12.3%, P = .196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs 9.7%, P = .036). CONCLUSIONS: The period after introducing an On-Call Specialist Aortic Rota was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00) and accompanied by a practice-pattern shift towards more extensive repairs. Given the observational design and potential for residual confounding and calendar-time bias, these findings should be viewed as associative rather than causal and require confirmation in multicentre studies with longer follow-up. CLINICAL TRIAL REGISTRY NUMBER: CEU/2019/11118.
Pruna‐Guillen et al. (Tue,) studied this question.