Faculty Bibliography

Objective: The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery program. Methods: Between May, 2005, and July, 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005-2009, n=39) and after (2010-2014, n=62) the implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection (IRAD) preoperative prediction model. Results: This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P=0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P<0.0001) and renal failure (P=0.034). No statistical difference in baseline demographics and IRAD-predictive variables were noted between groups (Table SA17-1). However, there was a 3.5-fold reduction in the observed to- expected (O/E) operative mortality ratio (1.52-0.44) (Fig. SA17-1). The success of the aortic program resulted in a 50%increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delays related to transfer from a secondary hospital. Conclusions: Patient outcomes can be improved if the surgical treatment of ATAAD were restricted to institutions with a high-volume multidisciplinary aortic surgery program. (Figure Presented)