Key result
Concentrating acute aortic dissection care to 12 high-volume centers in Germany, despite increasing transport time to 70 minutes, was projected to reduce 30-day mortality to 14%.
Why the study?
Does concentrating surgical care to high-volume centers reduce 30-day mortality in patients with acute type A aortic dissection despite longer transportation times?
Does concentrating surgical care to high-volume centers reduce 30-day mortality in patients with acute type A aortic dissection despite longer transportation times?
A proposed model suggests that centralizing acute aortic dissection care to high-volume centers could improve survival despite increased transport times.
In this issue of the Journal, Goehlich et al. [1] introduce a model of transportation for patients with acute aortic dissection and project a scenario of improved care for type A dissection by concentrating surgical care to 12 specialized high-volume centres for the entire country of Germany with a population of 82 million. According to their model, by accepting a transportation time of 70 min (rather than the current average transport time of 36 min to any cardiosurgical department), the number of specialized centres for acute surgical care in aortic dissection could be reduced from 76 to 12 high-volume units strategically dotted around the country, even portending a reduction of 30-day mortality to 14%; those 12 centres would all surpass the caseload of >30 acute type A cases per annum [2]. The authors conclude that an acute aortic care network of 12 high-volume aortic centres (rather than 76 departments of cardiac surgery) outweighs longer transportation time of 70 versus 36 min.
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Nienaber et al. (2024) conducted an editorial in Acute aortic dissection (type A). Concentrating surgical care to 12 specialized high-volume centres vs. Current care (76 departments of cardiac surgery) was evaluated on 30-day mortality. Concentrating acute aortic dissection care to 12 high-volume centers in Germany, despite increasing transport time to 70 minutes, was projected to reduce 30-day mortality to 14%.
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