Aortic Center: Specialized Care Improves Outcomes and Decreases Mortality

Sales, Marcela da Cunha; Filho, José Dario Frota; Aguzzoli, Cristiane; Souza, Leonardo Dornelles; Rösler, Álvaro Machado; Lúcio, Eraldo; Pontes, Mauro Ricardo Nunes; Lucchese, Fernando

doi:10.5935/1678-9741.20140122

Cited by 9 publications

(8 citation statements)

References 41 publications

(42 reference statements)

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“…Furthermore, for confidentiality reasons, hospital names and characteristics are not included in the SNHDD, so this information could not be analyzed. Not all hospitals may have the same expected result, and the more specialized centers may have better outcomes, as described earlier [26] . However, we think this would not affect our main results because we included all Spanish hospitals, beside their characteristics, over the 15-year period.…”

Section: Factors Associated With Ihm (Table 4)mentioning

confidence: 89%

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

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Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

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Section: Factors Associated With Ihm (Table 4)mentioning

confidence: 89%

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

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“…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.

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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.

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“…Specialist aortic care improves outcomes and decrease mortality in patient affected by AAS. Aortic centres Study Random effects model Heterogeneity: I 2 = 50% Test for overall effect: z = -4.65, P< 0.01 Albrink et al, 21 1994 Harris et al, 27 2010 Davies et al, 26 2010 Sales et al, 35 2014 Andersen et al, 33 2014 Grau et al, 37 2015 Beller et al, 36 2015 Andersen et al, 42 2016 Shin et al, 46 On-call aortic (surgical) team Figure 4. Forest plots with unadjusted risk estimates for in-hospital/30-day mortality in hospitals with dedicated multidisciplinary standardized care for acute aortic syndromes (before and after implementation, upper panel) and hospitals with dedicated on-call aortic team (lower panel).…”

Section: Resultsmentioning

confidence: 99%

Aortic centres should represent the standard of care for acute aortic syndrome

Mariscalco

Maselli

Zanobini

et al. 2018

Eur J Prev Cardiolog

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Background Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods The design was a quantitative and qualitative review of observational studies. We searched PubMed/ MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46-0.56, and OR 0.41, 95% CI 0.25-0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45-0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19-0.5, and OR 0.37; 95% CI 0.15-0.87, respectively). Conclusions We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.

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Aortic Center: Specialized Care Improves Outcomes and Decreases Mortality

Cited by 9 publications

References 41 publications

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

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

Aortic centres should represent the standard of care for acute aortic syndrome

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