Impact of surgical experience on outcome in surgery of acute type A aortic dissection†

Lenos, Aristidis; Bougioukakis, Petros; Irimie, Vadim; Zacher, Michael; Diegeler, Anno; Urbanski, Paul P.

doi:10.1093/ejcts/ezu454

Cited by 48 publications

(37 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar observation was also reported in a registry study (GERAADA) where the mortality rate is slightly lower in the hemiarch group (6). Despite our findings that total arch replacement was not associated with significantly higher mortality compared to the more conservative approach, the results may not be seen in low volume centers where most patients with acute dissection undergo surgery (34). More importantly, the higher incidence of pre-operative cardiogenic shock and tamponade in the hemiarch cohort (P=0.0003) may theoretically increase the mortality, resulting in comparable pooled mortality results between the two groups.…”

Section: Discussioncontrasting

confidence: 67%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

127

View full text Add to dashboard Cite

Background: Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.Methods: A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I 2 =0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation.Conclusions: Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.

show abstract

Section: Discussioncontrasting

confidence: 67%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

127

View full text Add to dashboard Cite

show abstract

“…Although regional networks for the rapid triage and transfer of ST-segment elevation myocardial infarction (STEMI) (7,8) and trauma patients to specialized centers are well established, ATAAD patients are less amenable to centralization than other emergent/unstable patients due to the inability to diagnose ATAAD in the prehospital setting and the exceedingly small number of high-volume aortic dissection centers in the United States (4)(5)(6). Nonetheless, centralization of acute aortic dissection (AAD) care is an emerging focus of national quality improvement in cardiovascular medicine and likely offers the single best opportunity to improve outcomes from this challenging disease (9)(10)(11)(12)(13)(14)(15)(16), aside from prevention (17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

The utility of the aortic dissection team: outcomes and insights after a decade of experience

Andersen¹,

Benrashid²,

Ross³

et al. 2016

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Mortality rates following acute type A aortic dissection (ATAAD) repair are reduced when operations are performed by a high-volume acute aortic dissection (AAD) team, leading to efforts to centralize ATAAD care. Here, we describe our experience with ATAAD repair by our AAD team over the last 10 years, with a focus on patient selection, transfer protocols, operative approach, and volume trends over time.Methods: An AAD team was implemented at our institution in 2005, with dedicated high-volume AAD surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair. Further process improvements were made in 2013 to facilitate the rapid transfer of ATAAD patients to our institution using stream-lined triage, diagnostic, and transfer protocols for patients with suspected ATAAD (RACE-AD protocol). Volume trends and outcomes were assessed longitudinally over this period. in-hospital mortality rates of less than 10% were maintained over the study period.Conclusions: Centralization of ATAAD care has begun to occur at our center, with maintenance of low mortality rates for ATAAD repair. These data confirm a net positive impact on regional ATAAD outcomes through transfer of patients to a high-volume center with dedicated AAD surgeons.

show abstract

“…For our own centre, 30-day mortality has been 16.0% between 2004 and 2015, with 7.1% mortality in the hands of an experienced surgeon using routine axillary cannulation and an open arch approach during replacement of the ascending aorta. Still, outcomes after surgery are greatly influenced by the experience of the operating surgeon 27. We and other centres have established quality standards for AAD since 2011, comprising features such as on-call rotas for AAD between different hospitals, specialised in AAD services.…”

Section: Type a Aad (Debakey I And Ii)mentioning

confidence: 99%

Aortic dissection: medical, interventional and surgical management

Silaschi

Byrne

Wendler

2016

Heart

View full text Add to dashboard Cite

Impact of surgical experience on outcome in surgery of acute type A aortic dissection†

Cited by 48 publications

References 23 publications

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

The utility of the aortic dissection team: outcomes and insights after a decade of experience

Aortic dissection: medical, interventional and surgical management

Contact Info

Product

Resources

About