P168. Improving Outcomes in Acute Type A Aortic Dissection: The Impact of an On-Call Specialist Aortic Rota in Outcomes and Repair Complexity
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Barcelona/Spain
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Dr. Robert Pruna-Guillen completed his cardiovascular surgery training at Hospital Clínic Barcelona. Currently, he occupies the position of aortic fellow at St Barts Heart Centre in London, UK.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
Acute type A aortic dissection (ATAD) repair is a complex and high-risk procedure, often associated with a significant in-hospital mortality rate. We sought to evaluate the impact of implementing an aortic-specialist On-call Rota within our department on the outcomes of ATAD repair.
Methods:
Between January 2015 and October 2023, a total of 406 ATAD surgical repairs were performed. In September 2020, we introduced an aortic-specialist On-call Rota, which required surgeons to have a minimum of 10 major aortic cases per year and 4 ATAD repair cases per year. We compared outcomes between two groups: the pre-specialist Rota group (Group A) and the post-specialist Rota group (Group B).
Results:
There were no significant differences in preoperative patient characteristics between the two groups. The mean age was 59 years (18-89), and 68% of the patients were male.
The overall in-hospital mortality rate was 21.6% (88 out of 406 patients). Notably, we observed a significant decrease in mortality in the post-specialist Rota group (B), with a rate of 16.4% (28 out of 170) compared to 25.4% (60 out of 236) in the pre-specialist Rota group (A) (p-value = 0.03).
While there were no significant differences in operative techniques between the two groups, we noted a trend toward more complex repairs since the introduction of the Rota. Aortic root replacement was performed in 44% of Group B cases compared to 35% in Group A, and total arch replacement using a frozen elephant trunk (FET) technique was employed in 20% of Group B cases compared to 14% in Group A. Inversely, interposition graft alone was used in 38% of Group B cases compared to 45% in Group A. Consequently, longer cardiopulmonary bypass (CPB), cross-clamp, and circulatory arrest times were observed in Group B.
There were no significant differences in postoperative complications between the two groups, but lower incidence of permanent stroke (11% vs 15%), tracheostomy (14% vs 20%), or temporary dialysis (25% vs 31%) was observed in post-specialist Rota group B vs pre-specialist Rota group A, respectively.
Conclusion:
The implementation of an aortic-specialist On-call Rota for the surgical treatment of ATAD has a positive impact on in-hospital mortality and morbidity outcomes. Additionally, there is a discernible trend toward more complex repairs following the introduction of a specialist aortic Rota.
Authors
Robert Pruna-Guillen (1), Mehmet Alagoz (2), Benjamin Adams (3), Carmelo Di Salvo (4), Kulvinder Lall (5), John Yap (5), Rakesh Uppal (5), Aung Oo (3), Ana Lopez-Marco (4)
Institutions
(1) Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK., (2) University of Texas Health Science at Houston, 0, United States, (3) Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK., London, NA, (4) St Bartholomew's Hospital, London, London, (5) St Bartholomew hospital, London, NA
Acute type A aortic dissection (ATAD) repair is a complex and high-risk procedure, often associated with a significant in-hospital mortality rate. We sought to evaluate the impact of implementing an aortic-specialist On-call Rota within our department on the outcomes of ATAD repair.
Methods:
Between January 2015 and October 2023, a total of 406 ATAD surgical repairs were performed. In September 2020, we introduced an aortic-specialist On-call Rota, which required surgeons to have a minimum of 10 major aortic cases per year and 4 ATAD repair cases per year. We compared outcomes between two groups: the pre-specialist Rota group (Group A) and the post-specialist Rota group (Group B).
Results:
There were no significant differences in preoperative patient characteristics between the two groups. The mean age was 59 years (18-89), and 68% of the patients were male.
The overall in-hospital mortality rate was 21.6% (88 out of 406 patients). Notably, we observed a significant decrease in mortality in the post-specialist Rota group (B), with a rate of 16.4% (28 out of 170) compared to 25.4% (60 out of 236) in the pre-specialist Rota group (A) (p-value = 0.03).
While there were no significant differences in operative techniques between the two groups, we noted a trend toward more complex repairs since the introduction of the Rota. Aortic root replacement was performed in 44% of Group B cases compared to 35% in Group A, and total arch replacement using a frozen elephant trunk (FET) technique was employed in 20% of Group B cases compared to 14% in Group A. Inversely, interposition graft alone was used in 38% of Group B cases compared to 45% in Group A. Consequently, longer cardiopulmonary bypass (CPB), cross-clamp, and circulatory arrest times were observed in Group B.
There were no significant differences in postoperative complications between the two groups, but lower incidence of permanent stroke (11% vs 15%), tracheostomy (14% vs 20%), or temporary dialysis (25% vs 31%) was observed in post-specialist Rota group B vs pre-specialist Rota group A, respectively.
Conclusion:
The implementation of an aortic-specialist On-call Rota for the surgical treatment of ATAD has a positive impact on in-hospital mortality and morbidity outcomes. Additionally, there is a discernible trend toward more complex repairs following the introduction of a specialist aortic Rota.
Authors
Robert Pruna-Guillen (1), Mehmet Alagoz (2), Benjamin Adams (3), Carmelo Di Salvo (4), Kulvinder Lall (5), John Yap (5), Rakesh Uppal (5), Aung Oo (3), Ana Lopez-Marco (4)
Institutions
(1) Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK., (2) University of Texas Health Science at Houston, 0, United States, (3) Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK., London, NA, (4) St Bartholomew's Hospital, London, London, (5) St Bartholomew hospital, London, NA
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.