P156. The Surgeon Effect: Volume-Outcome Relationship in Acute Type A Aortic Dissection
Presented During: Adult Cardiac Poster Session II
UPMC Presbyterian
Pittsburgh, PA
United States - Contact Me
Board Certified General Surgeon
Cardiothoracic Surgery Fellow at UPMC
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
Objective: Despite advancements in technical and perioperative care, surgery for acute type A aortic dissection (ATAAD) carries significant morbidity and mortality. Prior studies have demonstrated that center volume influences outcomes. This study evaluates whether high-volume aortic surgeons independently improve perioperative and long-term outcomes compared to their low-volume counterparts.
Methods: Patients with acute type A aortic dissection from 2011–2024 were identified. Patients younger than eighteen years old, and with prior aortic intervention were excluded. A high-volume surgeon was considered one who performed surgery on more than 10 patients a year with ATAAD. Patients were stratified based on the operating surgeon performing their surgery – high versus low volume aortic surgeons. Endpoints included operative and long-term mortality apart from postoperative outcomes.
Results: A total of 705 patients underwent ATAAD repair; 635 (90.1%) were operated on by high-volume surgeons and 70 (9.9%) by low-volume surgeons. Preoperative demographics were similar, although patients operated on by low-volume surgeons had lower rates of malperfusion (9.9% vs 17.4% p=0.024), lower prevalence of peripheral vascular disease (22.5% vs. 38.1%, p=0.01) and less likely to have previous cardiac surgery (5.6% vs. 14.4%, p=0.04). High-volume surgeons performed significantly more aortic root reconstructions (64.1% vs. 43.7%, p=0.001 and frozen elephant trunk procedures (10.6% vs 4.2% p=0.08). High-volume surgeons were associated with lower 30-day mortality (12.5% vs. 22.5%, p=0.017), fewer reoperations for bleeding (16.5% vs. 26.8%, p=0.03), and reduced ICU hours (median 69.3 vs. 112, p<0.001). No significant differences were observed in five-year survival (71.8% vs. 74.9%, p=0.567) or postoperative stroke. However, Kaplan–Meier survival analysis showed that patients operated by a high-volume surgeon had superior overall survival (log-rank, p = 0.04). Multivariable regression demonstrated that age, dialysis, hypertension, and frozen elephant trunk procedures were predictors of mortality.
Conclusions: High-volume surgeons were associated with superior early outcomes in ATAAD repair, including lower operative mortality, reoperation for bleeding, and ICU utilization, despite performing more complex procedures. These findings may support prioritizing surgeon-specific experience in care pathways for surgery for acute type A aortic dissection.
Authors
MANUEL GIRALDO GRUESO (1), Aryan Meknat (2), Derek Serna-Gallegos (3), Irsa Hasan (4), Takuya Ogami (3), Johannes Bonatti (1), David Kaczorowski (5), Danny Chu (3), Ibrahim Sultan (3)
Institutions
(1) UPMC Presbyterian, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh Medical Center, Pittsburg, PA, (5) University of Pittsburgh, Venetia, PA
Methods: Patients with acute type A aortic dissection from 2011–2024 were identified. Patients younger than eighteen years old, and with prior aortic intervention were excluded. A high-volume surgeon was considered one who performed surgery on more than 10 patients a year with ATAAD. Patients were stratified based on the operating surgeon performing their surgery – high versus low volume aortic surgeons. Endpoints included operative and long-term mortality apart from postoperative outcomes.
Results: A total of 705 patients underwent ATAAD repair; 635 (90.1%) were operated on by high-volume surgeons and 70 (9.9%) by low-volume surgeons. Preoperative demographics were similar, although patients operated on by low-volume surgeons had lower rates of malperfusion (9.9% vs 17.4% p=0.024), lower prevalence of peripheral vascular disease (22.5% vs. 38.1%, p=0.01) and less likely to have previous cardiac surgery (5.6% vs. 14.4%, p=0.04). High-volume surgeons performed significantly more aortic root reconstructions (64.1% vs. 43.7%, p=0.001 and frozen elephant trunk procedures (10.6% vs 4.2% p=0.08). High-volume surgeons were associated with lower 30-day mortality (12.5% vs. 22.5%, p=0.017), fewer reoperations for bleeding (16.5% vs. 26.8%, p=0.03), and reduced ICU hours (median 69.3 vs. 112, p<0.001). No significant differences were observed in five-year survival (71.8% vs. 74.9%, p=0.567) or postoperative stroke. However, Kaplan–Meier survival analysis showed that patients operated by a high-volume surgeon had superior overall survival (log-rank, p = 0.04). Multivariable regression demonstrated that age, dialysis, hypertension, and frozen elephant trunk procedures were predictors of mortality.
Conclusions: High-volume surgeons were associated with superior early outcomes in ATAAD repair, including lower operative mortality, reoperation for bleeding, and ICU utilization, despite performing more complex procedures. These findings may support prioritizing surgeon-specific experience in care pathways for surgery for acute type A aortic dissection.
Authors
MANUEL GIRALDO GRUESO (1), Aryan Meknat (2), Derek Serna-Gallegos (3), Irsa Hasan (4), Takuya Ogami (3), Johannes Bonatti (1), David Kaczorowski (5), Danny Chu (3), Ibrahim Sultan (3)
Institutions
(1) UPMC Presbyterian, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh Medical Center, Pittsburg, PA, (5) University of Pittsburgh, Venetia, PA
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
View Submission
ADULT CARDIAC
Aorta and Great Vessels