Operative Strategies and Outcomes in Type a Aortic Dissection after the Enactment of a Multidisciplinary Aortic Surgery Team

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multi-disciplinary aortic surgery team. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005–2009, N = 39) and after (2010–2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P &lt; 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team. </jats:p></jats:sec>

Valve-sparing root replacement in type A dissection: Age and experience matter

“…The finding of a benefit of VSRR relative to conduit root replacement is not new. 6,7 The information provided by this study, coupled with data from other studies looking at surgeon expertise 4,8 and center volume 9 could reasonably conclude that for patients with TAAD, VSRR is a preferable approach if the patient's preoperative characteristics are favorable, if the surgeon has the expertise, and if the institution has the volume experience. These caveats are not unreasonable, and as Rosenblum and colleagues 5 at Emory have shown, optimal.…”

“…3 The introduction of dedicated aortic specialists has led to further reductions in mortality to less than 10%. 4 In this issue of the Journal, the Emory group of Rosenblum and colleagues 5 present their single-institution experience with the subgroup of patients with TAAD who required root replacement. They further subdivided this cohort into those patients in whom the root was addressed with a composite valved conduit (conduit root group) and those who underwent a valve-sparing root replacement (VSRR group).…”

Discuss Many to Benefit More – Fünf-Jahres-Analyse eines interdisziplinären Aortenkolloquium

“…Multidisziplinäre Therapiekonzepte gehen in der Aortenchirurgie mit einem Vorteil für den Patienten hinsichtlich Therapieentscheid und klinischem Verlauf einher [1,2]. Die Versorgung von Patienten mit aortalen Pathologien erfolgt heutzutage im Idealfall in zertifizierten Aortenzentren [3].…”

A novel anesthesiologist‐led multidisciplinary model for evaluating high‐risk surgical patients at a comprehensive cancer center

“…The discussion at these meetings is usually centered specifically on a particular cancer diagnosis and therapeutic options available to the patient, not just surgical ones. Review of surgical cases is typically done at the department level among fellow surgeons with certain consultants (ie, radiologists) and focuses on surgery‐specific considerations (ie, the surgical technique) rather than a broader perspective of the patient . There is increasing interest to foster more collaboration in surgical care, especially for high‐risk patients; however, this approach will require a cultural shift and a commitment by all team members to share accountability for outcomes of surgical or nonsurgical care .…”