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

Publication ,  Journal Article
Andersen, ND; Ganapathi, AM; Hanna, JM; Williams, JB; Gaca, JG; Hughes, GC
Published in: J Am Coll Cardiol
May 6, 2014

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.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 6, 2014

Volume

63

Issue

17

Start / End Page

1796 / 1803

Location

United States

Related Subject Headings

  • Young Adult
  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Registries
  • Preoperative Period
  • Postoperative Period
 

Citation

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Andersen, N. D., Ganapathi, A. M., Hanna, J. M., Williams, J. B., Gaca, J. G., & Hughes, G. C. (2014). Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol, 63(17), 1796–1803. https://doi.org/10.1016/j.jacc.2013.10.085
Andersen, Nicholas D., Asvin M. Ganapathi, Jennifer M. Hanna, Judson B. Williams, Jeffrey G. Gaca, and G Chad Hughes. “Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program.J Am Coll Cardiol 63, no. 17 (May 6, 2014): 1796–1803. https://doi.org/10.1016/j.jacc.2013.10.085.
Andersen ND, Ganapathi AM, Hanna JM, Williams JB, Gaca JG, Hughes GC. Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol. 2014 May 6;63(17):1796–803.
Andersen, Nicholas D., et al. “Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program.J Am Coll Cardiol, vol. 63, no. 17, May 2014, pp. 1796–803. Pubmed, doi:10.1016/j.jacc.2013.10.085.
Andersen ND, Ganapathi AM, Hanna JM, Williams JB, Gaca JG, Hughes GC. Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol. 2014 May 6;63(17):1796–1803.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 6, 2014

Volume

63

Issue

17

Start / End Page

1796 / 1803

Location

United States

Related Subject Headings

  • Young Adult
  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Registries
  • Preoperative Period
  • Postoperative Period