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. 2025 Oct;41(10):1408-1416.
doi: 10.1007/s12055-025-02038-y. Epub 2025 Sep 4.

Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey

Lokeswara Rao Sajja  1   2 , Gopichand Mannam  1 , Prashanthi Beri  2 , Balakrishna Nagalla  2   3
Affiliations

Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey

Lokeswara Rao Sajja et al. Indian J Thorac Cardiovasc Surg. 2025 Oct.

Abstract

Purpose: The management of acute type A aortic dissection (ATAAD) remains a challenge in cardiac surgery, with significant variability in practices influenced by surgeon experience, institutional resources, and patient demographics. This survey aims to evaluate the current trends in ATAAD management among Indian cardiac surgeons.

Methods: A nationwide survey was conducted among Indian cardiac surgeons, collecting data on preoperative, intraoperative, and postoperative practices, as well as surgeon demographics and institutional case volumes. The survey questionnaire was distributed to 380 active Indian cardiac surgeons. Key trends and factors influencing decision-making were analyzed.

Results: Two hundred surgeons responded to the survey questionnaire. In patients over 80 years of age, the management was conservative, with 73.49% of surgeons avoiding surgery. Timing of surgery within 24 h was prioritized by 68.37%. Axillary artery cannulation (55.81%) and antegrade cerebral perfusion (77.67%) were the most favored techniques. Deep hypothermia (18-20 °C) was used by 26.51% of surgeons, and moderate hypothermia (25-28 °C) was increasingly used by 32.09% of surgeons during circulatory arrest. Postoperative surveillance relied mainly on computed tomography angiography (CTA) (88.37%), while magnetic resonance angiography (MRA) was underutilized (19.53%). High-volume surgeons and centers were more likely to adopt advanced techniques. Barriers included limited access to resources, specialized training, and regional disparities in healthcare infrastructure.

Conclusion: This study highlights significant variability in ATAAD management practices in India, underscoring the need for standardized guidelines tailored to the local context. Investments in training, infrastructure, and regional referral systems are essential to harmonize care and improve outcomes. India has the potential to optimize ATAAD management and enhance patient survival.

Graphical abstract: Sajja, L.R., Mannam, G., Beri, P., Nagalla B. Indian Journal of Thoracic and Cardiovascular Surgery. Central picture: Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02038-y.

Keywords: Aortic cannulation; Aortic dissection; Cerebral perfusion; Hypothermia; National survey.

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Conflict of interest statement

Conflict of interestThe author(s) declare(s) that there is no conflict of interest and no funding involved for this study.

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