Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May 6;63(17):1796-803.
doi: 10.1016/j.jacc.2013.10.085. Epub 2014 Jan 8.

Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program

Nicholas D Andersen  1 , Asvin M Ganapathi  1 , Jennifer M Hanna  1 , Judson B Williams  1 , Jeffrey G Gaca  1 , G Chad Hughes  2
Affiliations

Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program

Nicholas D Andersen et al. J Am Coll Cardiol. .

Abstract

Objectives: The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume thoracic aortic surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair.

Background: Outcomes of ATAAD repair may be improved when operations are performed at specialized high-volume thoracic aortic surgical centers.

Methods: Between 1999 and 2011, 128 patients underwent ATAAD repair at our institution. Records of patients who underwent ATAAD repair 6 years before (n = 56) and 6 years after (n = 72) implementation of the TASP were retrospectively compared. Expected operative mortality rates were calculated using the International Registry of Acute Aortic Dissection pre-operative prediction model.

Results: Baseline risk profiles and expected operative mortality rates were comparable between patients who underwent surgery before and after implementation of the TASP. Operative mortality before TASP implementation was 33.9% and was statistically equivalent to the expected operative mortality rate of 26.0% (observed-to-expected mortality ratio 1.30; p = 0.54). Operative mortality after TASP implementation fell to 2.8% and was statistically improved compared with the expected operative mortality rate of 18.2% (observed-to-expected mortality ratio 0.15; p = 0.005). Differences in survival persisted over long-term follow-up, with 5-year survival rates of 85% observed for TASP patients compared with 55% for pre-TASP patients (p = 0.002).

Conclusions: ATAAD repair can be performed with results approximating those of elective proximal aortic surgery when operations are performed by a high-volume multidisciplinary thoracic aortic surgery team. Efforts to standardize or centralize care of patients undergoing ATAAD are warranted.

Keywords: aortic dissection; aortic surgery; outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Observed and Expected Operative Mortality Rates for Acute Type A Aortic Dissection Repair
Figure 2
Figure 2. Kaplan-Meier Estimates of Survival Stratified by Era
N = number at risk; SE = standard error.
Figure 3
Figure 3. Distribution of Surgeons Performing Acute Type A Aortic Dissection Repairs Over Time
Between 1999 and 2011, 128 acute type A aortic dissection repairs were performed by 13 different surgeons. Open circles = survivors and black diamonds = deaths.
See this image and copyright information in PMC

Comment in

References

    1. Knipp BS, Deeb GM, Prager RL, Williams CY, Upchurch GR, Jr, Patel HJ. A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States. Surgery. 2007;142:524–8. - PubMed
    1. Williams JB, Peterson ED, Zhao Y, et al. Contemporary results for proximal aortic replacement in North America. J Am Coll Cardiol. 2012;60:1156–62. - PMC - PubMed
    1. Chikwe J, Cavallaro P, Itagaki S, Seigerman M, Diluozzo G, Adams DH. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality. Ann Thorac Surg. 2013;95:1563–9. - PubMed
    1. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD) Eur J Vasc Endovasc Surg. 2009;37:149–59. - PubMed
    1. Bonser RS, Ranasinghe AM, Loubani M, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58:2455–74. - PubMed

Publication types

MeSH terms