Aortic centres should represent the standard of care for acute aortic syndrome. (29th August 2020)

• Record Type: Journal Article
• Authors: Mariscalco, Giovanni; Maselli, Daniele; Zanobini, Marco; Ahmed, Aamer; Bruno, Vito D; Benedetto, Umberto; Gherli, Riccardo; Gherli, Tiziano; Nicolini, Francesco
• Is Part Of: European journal of preventive cardiology. Volume 25(2018)Supplement 1
• Page Start: 3
• Page End: 14
• Publication Date: 2020-08-29
• Subjects: Acute aortic syndrome -- aortic dissections -- meta-analysis -- hospital volume -- surgeon volume -- quality of health care; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1177/2047487318764963
• Languages: English
• ISSNs: 2047-4873

Abstract

Abstract: Background: Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods: The design was a quantitative and qualitative review of observational studies. We searched PubMed / MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results: A total of 79, 131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). Conclusions: We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.