ObjectiveTo compare in-hospital outcomes in aortic surgery in our cardiac surgery unit,
before and after foundation of our Center for Aortic Surgery (CTA).MethodsProspective cohort with non-concurrent control. Foundation of CTA required
specialized training of surgical, anesthetic and intensive care unit teams,
routine neurological monitoring, endovascular and hybrid facilities, training of
the support personnel, improvement of the registry and adoption of specific
protocols. We included 332 patients operated on between: January/2003 to
December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA,
n=175, 52.7%). Baseline clinical and demographic data, operative variables,
complications and in-hospital mortality were compared between both groups.ResultsMean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of
diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular
procedures, and aneurysms. In the univariate analysis, CTA had lower mortality
(9.7 vs. 23.0%, P=0.008), which occurred consistently across
different diseases and procedures. Other outcomes which were reduced in CTA
included lower rates of reinterventions (5.7 vs 11%, P=0.046),
major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs.
10.9%, P=0.045) and sepsis (1.7 vs. 9.6%,
P=0.001), as compared to before-CTA. Multivariable analysis
adjusted for potential counfounders revealed that CTA was independently associated
with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007).
CTA independent mortality reduction was consistent in the multivariable analysis
stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98,
P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99,
P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 –
0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904,
P=0.037). Additional multivariable predictors of in-hospital
mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008), urgent
surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal
aneurysm (OR=24.6 [3.1-194.1], P=0.002).ConclusionThoracic aorta surgery in specialized center was associated with lower incidence
of complications and all-cause mortality as compared to usual care.