Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikel

DOI

    Arnar Geirsson, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA., Anders Ahlsson, Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, School of Health and Medicine, Orebro University, Orebro, Sweden., Anders Franco-Cereceda, Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.,
  • Simon Fuglsang
  • Jarmo Gunn, Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland., Emma C Hansson, University of Gothenburg,
  • Vibeke Hjortdal
  • Kati Jarvela, Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland., Anders Jeppsson, University of Gothenburg, Ari Mennander, Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland., Shahab Nozohoor, Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Christian Olsson, Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden., Emily Pan, Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland., Anders Wickbom, Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, School of Health and Medicine, Orebro University, Orebro, Sweden., Igor Zindovic, Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Tomas Gudbjartsson, a Landspitali University Hospital, Faculty of Medicine, University of Iceland , Reykjavik Iceland.

OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.

METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.

RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 ( P  < 0.001). Chest pain was present in 85% of patients, 24% were hypotensive on presentation and 28% had malperfusion syndrome. Open distal anastomosis technique under hypothermic circulatory arrest was used in 85% of cases and its use increased significantly throughout the study. The 30-day mortality decreased from 24% in 2005 to 13% in 2014 ( P  = 0.003). Independent predictors for 30-day mortality were preoperative cardiac arrest, malperfusion syndrome, Penn Class C, Penn Class B and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival.

CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year of operation and increased the number of operations performed per year, indicating that cumulative surgical experience contributes significantly to improved surgical outcomes.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Cardio-Thoracic Surgery
Vol/bind53
Tidsskriftsnummer1
Sider (fra-til)276-281
Antal sider6
ISSN1010-7940
DOI
StatusUdgivet - 2018

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