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
. 2021 Dec 28;43(1):44-52.
doi: 10.1093/eurheartj/ehab586.

Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit

Umberto Benedetto  1 , Arnaldo Dimagli  1 , Amit Kaura  2 , Shubhra Sinha  1 , Giovanni Mariscalco  3 , George Krasopoulos  4 , Narain Moorjani  5 , Mark Field  6 , Trivedi Uday  7 , Simon Kendal  8 , Graham Cooper  9 , Rakesh Uppal  10 , Haris Bilal  11 , Jorge Mascaro  12 , Andrew Goodwin  8 , Gianni Angelini  1 , Geoffry Tsang  13 , Enoch Akowuah  8
Affiliations

Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit

Umberto Benedetto et al. Eur Heart J. .

Abstract

Aims: Operability of type A acute aortic dissections (TAAAD) is currently based on non-standardized decision-making process, and it lacks a disease-specific risk evaluation model that can predict mortality. We investigated patient, intraoperative data, surgeon, and centre-related variables for patients who underwent TAAAD in the UK.

Methods and results: We identified 4203 patients undergoing TAAAD surgery in the UK (2009-18), who were enrolled into the UK National Adult Cardiac Surgical Audit dataset. The primary outcome was operative mortality. A multivariable logistic regression analysis was performed with fast backward elimination of variables and the bootstrap-based optimism-correction was adopted to assess model performance. Variation related to hospital or surgeon effects were quantified by a generalized mixed linear model and risk-adjusted funnel plots by displaying the individual standardized mortality ratio against expected deaths. Final variables retained in the model were: age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.02-1.03; P < 0.001]; malperfusion (OR 1.79, 95% CI 1.51-2.12; P < 0.001); left ventricular ejection fraction (moderate: OR 1.40, 95% CI 1.14-1.71; P = 0.001; poor: OR 2.83, 95% CI 1.90-4.21; P < 0.001); previous cardiac surgery (OR 2.29, 95% CI 1.71-3.07; P < 0.001); preoperative mechanical ventilation (OR 2.76, 95% CI 2.00-3.80; P < 0.001); preoperative resuscitation (OR 3.36, 95% CI 1.14-9.87; P = 0.028); and concomitant coronary artery bypass grafting (OR 2.29, 95% CI 1.86-2.83; P < 0.001). We found a significant inverse relationship between surgeons but not centre annual volume with outcomes.

Conclusions: Patient characteristics, intraoperative factors, cardiac centre, and high-volume surgeons are strong determinants of outcomes following TAAAD surgery. These findings may help refining clinical decision-making, supporting patient counselling and be used by policy makers for quality assurance and service provision improvement.

Keywords: Risk factors; Risk score; Type A aortic dissection; Volume–outcome relationship.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Trend in number of surgeries for type A acute aortic dissection (overall and by type of procedure) (left) and overall mortality rates (right).
Figure 2
Figure 2
Funnel plots for hospital mortality 2009–19 in the UK stratified by hospitals (n = 35) (left) and surgeons (n = 509) (right).
See this image and copyright information in PMC

Comment in

References

    1. Mahase E. Half of patients with acute aortic dissection in England die before reaching a specialist centre. BMJ 2020;368:m304. - PubMed
    1. Braverman AC. Acute aortic dissection: clinician update. Circulation 2010;122:184–188. - PubMed
    1. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, Ehrlich MP, Trimarchi S, Braverman AC, Myrmel T, Harris KM, Hutchinson S, O'Gara P, Suzuki T, Nienaber CA, Eagle KA; IRAD Investigators. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation 2018;137:1846–1860. - PubMed
    1. Richens D, Briggs T. Cardiothoracic Surgery GIRFT Programme National Specialty Report GIRFT Is Delivered in Partnership with the Royal National Orthopaedic Hospital NHS Trust and NHS Improvement; 2018. (March).
    1. Howard DPJ, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM, Study OV. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 2013;127:2031–2037. A - PMC - PubMed

Publication types