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

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

  • Arnar Geirsson
    Arnar GeirssonSection of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA.
  • Anders Ahlsson
    Anders AhlssonDepartment of Cardiothoracic and Vascular Surgery, Orebro University Hospital, School of Health and Medicine, Orebro University, Orebro, Sweden.
  • Anders Franco-Cereceda
    Anders Franco-CerecedaDepartment of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
  • Simon Fuglsang
  • Jarmo Gunn
    Jarmo GunnDepartment of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
  • Emma C Hansson
    Emma C HanssonUniversity of Gothenburg
  • Vibeke Hjortdal
  • Kati Jarvela
    Kati JarvelaDepartment of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
  • Anders Jeppsson
    Anders JeppssonUniversity of Gothenburg
  • Ari Mennander
    Ari MennanderDepartment of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
  • Shahab Nozohoor
    Shahab NozohoorDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
  • Christian Olsson
    Christian OlssonDepartment of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
  • Emily Pan
    Emily PanDepartment of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
  • Anders Wickbom
    Anders WickbomDepartment of Cardiothoracic and Vascular Surgery, Orebro University Hospital, School of Health and Medicine, Orebro University, Orebro, Sweden.
  • Igor Zindovic
    Igor ZindovicDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
  • Tomas Gudbjartsson
    Tomas Gudbjartssona 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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