Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas

Arsalan, Mani; Squiers, John J.; Herbert, Morley A.; MacHannaford, Juan C.; Chamogeorgakis, Themistokles; Prince, Syma L.; Hamman, Baron L.; Knoff, Cathy; Moore, D. Blaine; Harrington, Katherine; DiMaio, J. Michael; Mack, Michael J.; Brinkman, William T.

doi:10.1016/j.amjcard.2016.09.034

Cited by 21 publications

(12 citation statements)

References 18 publications

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“…to save the life of the patient. In contemporary reports, the overall early mortality from ATAAD (30-day or in-hospital) in operated patients ranges from 5% to 24% [56][57][58][59] and has uniformly been around 17% in current multi-centre studies (German Registry of Acute Aortic Dissection type A, (GERAADA), 17%; International Registry of Aortic Dissection (IRAD), 18%; NORCAAD, 16%) [11,48,49]. Patients who are clinically stable with normal perfusion syndrome generally do well after surgery, with low mortality (of around 3%) [59,60].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Intervals for scheduled imaging after ATAAD have been described both in the EACTS/ESC 2014 guidelines and in the AHA/ACC 2010 guidelines [56,117]. In the case of a treated ATAAD, with or without persistent residual dissection, a follow-up CT of the aorta is recommended at 1 month (additionally at 3 months in the American guideliness), 6, and 12 months and annually thereafter [56,117]. The European guidelines state that with stable disease, imaging every two years after the first control after one year should suffice.…”

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

“…However, it should be noted that the recommendations for ATAAD are extrapolated from data on the natural course of type-B dissections, and arguably the residual dissection after a type A dissection should be considered to be a different entity. This is reflected by the guidelines stating that data on optimal surveillance schedules for ATAAD specifically are not available [56,117]. After valve-sparing surgery for acute dissection, aortic regurgitation at follow-up is almost exclusively associated with root dilatation, but the 5-year rates of moderate or greater aortic valve regurgitation or regurgitation as indication for reoperation have been reported to be below 5% in most series, including the NORCAAD registry [8,[118][119][120].…”

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

107

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

Section: Outcome and Long-term Follow-upmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

107

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“…The definition of a high-volume center varies, with some researchers using a threshold of 14 cases per year and others using more than 11 cases per year [6,7]. The situation in Western countries is different from that in Korea.…”

Section: Kjtcvs Discussionmentioning

confidence: 99%

“…In the United States and Europe, large-volume heart surgery centers have generally exhibited good results of aortic dissection surgery, while there are many reports of poor results at small-volume heart surgery centers [6][7][8]. In Korea, there is a tendency for surgical patients to be attracted to large-volume centers.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Type A Aortic Dissection at a Small- Volume Medical Center: Analysis according to the Extent of Surgery

Lee

Cho

Jang

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: Despite progress in treatment, Stanford type A aortic dissection is still a life-threatening disease. In this study, we analyzed surgical outcomes in patients with Stanford type A aortic dissection according to the extent of surgery at Daegu Catholic University Medical Center. Methods: We retrospectively analyzed 98 patients with Stanford type A aortic dissection who underwent surgery at our institution between January 2008 and June 2018. Of these patients, 82 underwent limited replacement (hemi-arch or ascending aortic replacement), while 16 patients underwent total arch replacement (TAR). We analyzed in-hospital mortality, postoperative complications, the overall 5-year survival rate, and the 5-year aortic event-free survival rate. Results: The median follow-up time was 48 months (range, 1-128 months), with a completion rate of 85.7% (n=84). The overall in-hospital mortality rate was 8.2%: 6.1% in the limited replacement group and 18.8% in the TAR group (p=0.120). The overall 5-year survival rate was 78.8% in the limited replacement group and 81.3% in the TAR group (p=0.78). The overall 5-year aortic event-free survival rate was 85.3% in the limited replacement group and 88.9% in the TAR group (p=0.46). Conclusion: The extent of surgery was not related to the rates of in-hospital mortality, complications, aortic events, or survival. Although this study was conducted at a small-volume center, the in-hospital mortality and 5-year survival rates were satisfactory.

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