Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection†

Geirsson, Arnar; Ahlsson, Anders; Franco‐Cereceda, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke E.; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Pan, Emily; Wickbom, Anders; Zindovic, Igor; Guðbjartsson, Tómas

doi:10.1093/ejcts/ezx231

Cited by 37 publications

(39 citation statements)

References 26 publications

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“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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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: Introductionmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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“…Preparation for the intervention requires transfer to a medical center with experience in management of AD, admission to ICU, and invasive arterial blood pressure monitoring [28,29]. Medical treatment called "anti-impulse therapy" is directed toward avoidance of aortic rupture and reduction of further propagation of the dissection by control of blood pressure and dP/dt (pressure development).…”

Section: Preoperative Managementmentioning

confidence: 99%

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

Iacona¹

2018

SMOAJ

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An intimal tear propagating within the media either proximally or distally is the primary etiology of aortic dissection. The tear can occurs anywhere in the aorta but more frequently in the ascending portion. The blood will flow predominantly in a new lumen called "false lumen" separated from the true lumen by a thin intimal flap and contained by the aortic adventitia. The false lumen may propagates propagate proximally all the way to the aortic valve and CRIMSONpublishers http://www.crimsonpublishers.com AbstractAcute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.

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“…3 Surgical mortality varies among different hospitals according to institutional volume and surgeon experience. 4 5 Dissection events have been shown to peak during early morning (6 a.m.–12 p.m.) and late afternoon hours. 6 Consequently, the majority of ATAD patients present at an unconventional time of the day, having no prior diagnosis of aortic disease, and usually require emergent, complex aortic replacement by an on-call cardiac surgeon.…”

Section: Introductionmentioning

confidence: 99%

Acute Type A Aortic Dissection Surgery Performed by Aortic Specialists Improves 2-Year Outcomes

Mahmood

Mori

Geirsson

et al. 2019

Aorta

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Objective In patients presenting with acute Type A aortic dissections (ATADs), the authors sought to evaluate whether emergent aortic operations performed by cardiac surgeons with different level of aortic surgery experience can impact perioperative outcomes and survival. Methods A single-center review of 102 patients who underwent aortic surgeries for ATAD was conducted. The cohort was divided into those operated on by aortic specialists (AS:3 surgeons) and non-AS (5 surgeons). Multivariable logistic regression and Cox proportional hazard models were fitted to evaluate associations between the surgeon experience, perioperative outcomes, and survival, respectively. Results Of 102 patients, 60 were operated on by AS and 42 were operated on by non-AS. Overall 30-day mortality was 11 (10.8%) with 4 (6.6%) perioperative deaths in the AS group and 7 (16.6%) among the non-AS group (p = 0.2). AS performed a significantly higher number of root replacement procedures (41.6% vs. 23.8%, respectively, p = 0.049) and employed more frequent adjunct cerebral perfusion during circulatory arrest (p = 0.003). Survival analysis indicated AS status was an independent predictor of improved 2-year survival (hazard ratio: 0.37, 95% confidence interval: 0.15–0.92, p = 0.03). Conclusion Operation by AS for ATAD was associated with reduced adjusted risk of 2-year mortality. This adds support for establishing thoracic aortic emergency call teams staffed by AS.

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Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection†

Cited by 37 publications

References 26 publications

Acute type A aortic dissection – a review

Acute type A aortic dissection – a review

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

Acute Type A Aortic Dissection Surgery Performed by Aortic Specialists Improves 2-Year Outcomes

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