A dedicated surgical team for acute type-A aortic dissection repair: its impact on patient and surgeon

P0010 

Abstract Submission 

Tim Smith (1), Guillaume Geuzebroek (1), Wilson Li (1), Michel Verkroost (1), Robin Heijmen (1)

(1) Radboudumc, Nijmegen, the Netherlands

Tim Smith    -  Contact Me
Radboudumc

Guillaume Geuzebroek    -  Contact Me
Radboudumc

Wilson Li    -  Contact Me
Radboudumc

Michel Verkroost    -  Contact Me
Radboudumc

Robin Heijmen    -  Contact Me
Radboudumc

Tim Smith    -  Contact Me
N/A

Objective: The inverse relationship between operative volume and outcome of surgical procedures has been indisputably shown in a variety of disease entities. Nonetheless, surgery for acute type-A aortic dissection (ATAAD) – a typical complex surgical emergency – is mainly performed by non-dedicated surgeons. This is often due to logistic reasons, including a high on-call burden. In this study, we report the observed consequences of dedicated surgical care for ATAAD in our high-volume thoracic aortic center.
Methods: From 2020, ATAAD surgery was preferably performed by two young, albeit experienced, aortic surgeons, supervised by a senior when deemed necessary. Early surgical outcome of the patients as well as the experienced work-life balance impact of the surgeons was retrospectively studied.
Results: Since January 2020, a total of 53 ATAAD patients were operated by the two dedicated surgeons. The mean age of the studied population was 62  11 years, 72% were males (n=38). The proximal repair consisted of composite aortic root replacement in 42% (n=22); 58% of patients (n=31) underwent resuspension of the aortic valve with reconstruction of the aortic root and supracoronary ascending aorta replacement. The distal repair consisted of hemi-arch repair in 64% (n=34), zone 1 arch replacement in 4% (n=2), zone 2 arch replacement with proximalization of brachiocephalic trunk and left common carotid in 24% (n=13), total arch replacement in 8% (n=4), including 2 with the Frozen Elephant Trunk technique. The mean cardiopulmonary bypass time was 261  81 min; the mean cross clamp time 160  49 min. Arterial cannulation was performed in the femoral artery in 81% (n=43), in the right axillary artery in 8% (n=4), and direct aortic cannulation was performed in 11% (n=6). Bilateral antegrade cerebral perfusion was used in 98% of cases (n=52). No operative mortality occurred, and only one in-hospital mortality (1.8%) was observed on post-operative day +16 due to late vein graft thrombosis in a patient who experienced iatrogenic ATAAD after PCI of the left mainstem in whom the left coronary ostium had to be sacrificed and the left coronary territory was grafted. Re-exploration due to bleeding was performed in 15% (n=8) of patients. New cerebral neurological deficits were observed in 8% (n=4) of patients. No paraplegia occurred. Renal function replacement therapy was temporarily used in 2 patients; no need for long-term dialysis was observed. Despite the positive motivation to maintain the effort given the obtained surgical results, both surgeons experienced an undesirable high burden of the dedicated on-call frequency to their work-life balance during the investigated period, resulting in early termination of this tight dedication trial.
Conclusions: Very favorable results of extensive, complex ATAAD repair are observed in this limited cohort of patient operated by two dedicated aortic surgeons only. However, both surgeons experienced an undesirably high burden of the on-call frequency to their work-life balance. It is conceivable that optimal care for ATAAD lies between the two extremes of generalized and highly specialized surgical teams to be maintained sustainable. One of the potential solutions may be cooperation within regional networks, aiming at providing the best surgical care for our patients and sustainability for our surgical teams.

Dissection