Impact of a streamlined rotational system for the management of acute aortic syndrome: sharing is caring. (27th November 2018)

• Record Type: Journal Article
• Authors: Vaja, Ricky; Talukder, Shagorika; Norkunas, Mindaugas; Hoffman, Ross; Nienaber, Christoph; Pepper, John; Rosendahl, Ulrich; Asimakopoulos, George; Quarto, Cesare
• Is Part Of: European journal of cardio-thoracic surgery. Volume 55:Number 5(2019)
• Page Start: 984
• Page End: 989
• Publication Date: 2018-11-27
• Subjects: Acute aortic syndrome -- Aortic team -- Dissection rota; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezy386
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Acute type A aortic dissection is an emergency associated with up to 30% of hospital mortality. It has been established that outcomes are improved with specialist aortic team care in high-volume centres. Most centres are limited to a small number of aortic specialists, thus making it logistically impractical to have a dedicated 24/7 single-centre service. In 2011, a rotational 24/7 service between 3 centres covering a geographical location was introduced including 24/7 access to a dissection 'Hotline'. METHODS: We analysed data since 2003 from a prospectively collected database. A total of 227 patients underwent surgery for acute aortic syndrome between 2003 and 2017. The results on outcomes were compared before and after the initiation of the dissection hotline and 24/7 dedicated service. RESULTS: We identified 128 patients from the pre-rotational group and 99 patients from the post-rotational group. Both groups were well matched in terms of demographics and comorbidities. In the post-rotational group, there was an increase in arch surgery (11.8% vs 20.2%, P : 0.07). The introduction of the rotational service reduced 30-day mortality (20% vs 8%, P : 0.010). The introduction of the service improved the overall long-term survival [ P : 0.04, hazard ratio 1.86; confidence interval (1.03–3.38)] in the multivariable analysis. There was no difference between the groups in postoperative complications. There was an increase in the median length of hospital stay in the post-rotational group (13 days vs 20 days, P : 0.014). CONCLUSIONS: A streamlined aortic dissection service allows for centralized care. This provides the referring centres with 24/7 access to an experienced aortic team and may improve patient outcomes.