Specialization in Acute Type A Aortic Dissection Repair: The Outcomes and Challenges

Area of Science:

• Cardiac Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Increasing specialization in cardiac surgery suggests improved outcomes with higher case volumes.
• The effectiveness of dedicated aortic surgeons (AS) in performing acute type A aortic dissection (ATAAD) repair requires investigation.

Purpose of the Study:

• To investigate the impact of surgeon subspecialization on outcomes for open surgical repair of ATAAD.
• To compare outcomes between aortic surgeons (AS) and non-aortic surgeons (NAS) performing ATAAD repair.

Main Methods:

• Retrospective analysis of 436 patients undergoing open ATAAD repair from 1996 to 2014.
• Patients were divided into two groups: those treated by AS (n=401) and NAS (n=35).
• Outcomes including mortality, composite endpoints, and long-term survival were compared between groups. Multivariable logistic regression was used to identify risk factors.

Main Results:

• The AS group had significantly lower intraoperative mortality (1.2% vs 5.7%), 30-day mortality (6.5% vs 17%), and composite outcomes (23% vs 46%) compared to the NAS group.
• Non-aortic surgeons (NAS) were identified as a risk factor for 30-day mortality (OR=4.4).
• Ten-year survival was significantly better for the AS group (66% vs 46%). NAS, age, COPD, acute stroke, and NYHA class III/IV were significant risk factors for long-term mortality.

Conclusions:

• Managing ATAAD by subspecialized aortic surgeons leads to improved short- and long-term patient outcomes.
• Consideration should be given to performing ATAAD repair by high-volume aortic surgeons to enhance patient results.