Acute Type A Aortic Dissection Surgery Performed by Aortic Specialists Improves 2-Year Outcomes

摘要

>Objective  In patients presenting with acute Type A aortic dissections (ATADs), the authors sought to evaluate whether emergent aortic operations performed by cardiac surgeons with different level of aortic surgery experience can impact perioperative outcomes and survival. >Methods  A single-center review of 102 patients who underwent aortic surgeries for ATAD was conducted. The cohort was divided into those operated on by aortic specialists (AS:3 surgeons) and non-AS (5 surgeons). Multivariable logistic regression and Cox proportional hazard models were fitted to evaluate associations between the surgeon experience, perioperative outcomes, and survival, respectively. >Results  Of 102 patients, 60 were operated on by AS and 42 were operated on by non-AS. Overall 30-day mortality was 11 (10.8%) with 4 (6.6%) perioperative deaths in the AS group and 7 (16.6%) among the non-AS group ( p  = 0.2). AS performed a significantly higher number of root replacement procedures (41.6% vs. 23.8%, respectively, p  = 0.049) and employed more frequent adjunct cerebral perfusion during circulatory arrest ( p  = 0.003). Survival analysis indicated AS status was an independent predictor of improved 2-year survival (hazard ratio: 0.37, 95% confidence interval: 0.15–0.92, p  = 0.03).>Conclusion Operation by AS for ATAD was associated with reduced adjusted risk of 2-year mortality. This adds support for establishing thoracic aortic emergency call teams staffed by AS.