Key result
Surgery for acute type A aortic dissection in the recent era was associated with significantly lower 30-day mortality compared to the earlier era (3.9% vs 14.6%, p=0.014).
Why the study?
It remains equivocal whether surgical outcomes for acute type A aortic dissection are improving.
Does recent surgical experience improve 30-day mortality in patients undergoing surgery for acute type A aortic dissection compared to earlier experience?
Cohort (n=204)
Does recent surgical experience improve 30-day mortality in patients undergoing surgery for acute type A aortic dissection compared to earlier experience?
Absolute Event Rate: 3.9% vs 14.6%
p-value: p=0.014
Recent surgical experience for acute type A aortic dissection is associated with significantly lower 30-day mortality and neurological insults, potentially due to fewer surgeons performing more procedures and conservative resection approaches.
ATAAD repair shows lower recent 30-day mortality; leaves open whether advances or selection explain the trend in this retrospective cohort.
Background. It remains equivocal if acute type A aortic dissection (ATAAD) surgical outcomes are improving. We analyzed current outcome trends to evaluate improvements and to identify predicting variables. Methods. From 2015 to 2020, 204 patients underwent surgery for ATAAD and were divided into recent (n = 102) and earlier (n = 102) groups. Uni- and multivariable statistical analysis was performed to identify predictors of 30-day mortality. Results. Thirty-day mortality decreased significantly in the recent group (3.9% vs 14.6%, p = .014). Prevalence of neurological insult also decreased significantly (13% vs 25%, p = .028). Other major complications remained unchanged. There was no statistically significant difference in overall 30-day mortality between low-volume vs high-volume surgeons (12.3% vs 7.3%, p = .21). The number of surgeons performing ATAAD procedures decreased from nine in 2015 to five in 2020. Preoperative lactate (OR 1.24, 95%CI 1.03–1.51), dissection of any arch vessel (OR 14.2, 95%CI 1.79–113), non-normal left ventricular ejection fraction (OR 12.5, 95%CI 2.54–61.6), biological composite graft (OR 19.1, 95%CI 2.75–133), concomitant coronary artery bypass grafting (OR 38.8, 95%CI 2.91–517) and intraoperative adverse event (OR 9.5, 95%CI 2.22–40.9) were statistically significant independent predictors of mortality. Conclusions. Early outcomes after ATAAD improved in the most recent experience. Part of the explanation may be fewer surgeons performing more procedures annually, a relatively conservative approach to the extent of aortic resection and ensuring adequate cerebral protection. Major complications remain prevalent and require attention to be further reduced.
No takes yet. Share an insight, caveat, or question.
Bjurbom et al. (2023) conducted a cohort in Acute type A aortic dissection (n=204). Recent surgical era vs. Earlier surgical era was evaluated on 30-day mortality (p=0.014). Surgery for acute type A aortic dissection in the recent era was associated with significantly lower 30-day mortality compared to the earlier era (3.9% vs 14.6%, p=0.014).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: