Why the study?
To evaluate whether emergent aortic operations performed by cardiac surgeons with differing levels of aortic surgery experience impact perioperative outcomes and survival in acute Type A aortic dissections.
Does emergent aortic surgery performed by aortic specialists improve 2-year survival in patients presenting with acute Type A aortic dissection compared to non-aortic specialists?
Does emergent aortic surgery performed by aortic specialists improve 2-year survival in patients presenting with acute Type A aortic dissection compared to non-aortic specialists?
Emergent surgery for acute Type A aortic dissection performed by dedicated aortic specialists is associated with a significantly reduced risk of 2-year mortality compared to non-specialists.
May support specialist teams for acute Type A dissection repair; leaves open randomized confirmation of benefit.
Objective In patients presenting with acute Type A aortic dissections (ATADs), the authors sought to evaluate whether emergent aortic operations performed by cardiac surgeons with different level of aortic surgery experience can impact perioperative outcomes and survival. Methods A single-center review of 102 patients who underwent aortic surgeries for ATAD was conducted. The cohort was divided into those operated on by aortic specialists (AS:3 surgeons) and non-AS (5 surgeons). Multivariable logistic regression and Cox proportional hazard models were fitted to evaluate associations between the surgeon experience, perioperative outcomes, and survival, respectively. Results Of 102 patients, 60 were operated on by AS and 42 were operated on by non-AS. Overall 30-day mortality was 11 (10.8%) with 4 (6.6%) perioperative deaths in the AS group and 7 (16.6%) among the non-AS group (p = 0.2). AS performed a significantly higher number of root replacement procedures (41.6% vs. 23.8%, respectively, p = 0.049) and employed more frequent adjunct cerebral perfusion during circulatory arrest (p = 0.003). Survival analysis indicated AS status was an independent predictor of improved 2-year survival (hazard ratio: 0.37, 95% confidence interval: 0.15–0.92, p = 0.03). Conclusion Operation by AS for ATAD was associated with reduced adjusted risk of 2-year mortality. This adds support for establishing thoracic aortic emergency call teams staffed by AS.
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Mahmood et al. (2019) studied this question.
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