Management of acute type A aortic dissection in the Nordic countries

Several aspects of acute type A aortic dissection (ATAAD) management remain debated. The strategies for arterial cannulation, cerebral protection, temperature management and extent of aortic resection are all contested. We aimed to explore and describe variations in the current management of patients with ATAAD in the Nordic countries, which form a limited geographic region with similar healthcare systems.

A 32-item questionnaire regarding the organizational and periprocedural aspects of care for patients with ATAAD was sent to 17 Nordic cardiac surgery units, prospective collaborators in the Nordic Consortium for Acute type A Aortic Dissection. Results were summarized using descriptive statistics.

The response rate was 12/17 (71%). Fifty-eight per cent of centres used femoral artery cannulation, of which two centres (17%) used femoral artery cannulation in addition to another method. Nine centres (75%) used cerebral perfusion in most of surgical repairs requiring HCA, and among those using cerebral perfusion, 92% opted for antegrade cerebral perfusion. Five centres (42%) stated that total arch replacements were never performed. Valve sparing root replacements were performed by seven centres (58%). Regarding postoperative surveillance, all centres reported that CT-scans were performed at 6-12 months intervals.

Although strategies for pre-, peri-, and postoperative management of patients with ATAAD could be expected to be reasonably similar, we found several differences in almost all aspects of management. The current survey may help identify relevant research questions that can be explored in the NORCAAD2 database, ultimately contributing to the development of consensus documents and guidelines.