Advanced

Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection

Geirsson, Arnar ; Ahlsson, Anders ; Franco-Cereceda, Anders ; Fuglsang, Simon ; Gunn, Jarmo ; Hansson, Emma C ; Hjortdal, Vibeke ; Jarvela, Kati ; Jeppsson, Anders and Mennander, Ari , et al. (2018) In European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 53(1). p.276-281
Abstract

OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.

METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.

RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 (P <... (More)

OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.

METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.

RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 (P < 0.001). Chest pain was present in 85% of patients, 24% were hypotensive on presentation and 28% had malperfusion syndrome. Open distal anastomosis technique under hypothermic circulatory arrest was used in 85% of cases and its use increased significantly throughout the study. The 30-day mortality decreased from 24% in 2005 to 13% in 2014 (P = 0.003). Independent predictors for 30-day mortality were preoperative cardiac arrest, malperfusion syndrome, Penn Class C, Penn Class B and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival.

CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year of operation and increased the number of operations performed per year, indicating that cumulative surgical experience contributes significantly to improved surgical outcomes.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Aged, 80 and over, Aneurysm, Dissecting/mortality, Aorta/surgery, Aortic Aneurysm/mortality, Female, Follow-Up Studies, Hospital Mortality/trends, Hospitals, High-Volume, Hospitals, Low-Volume, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Scandinavian and Nordic Countries/epidemiology
in
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
volume
53
issue
1
pages
276 - 281
publisher
Oxford University Press
external identifiers
  • pmid:28977415
ISSN
1010-7940
DOI
10.1093/ejcts/ezx231
language
English
LU publication?
no
additional info
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
id
5262234c-dabe-4266-b29c-332ef1201834
date added to LUP
2019-05-22 09:13:12
date last changed
2020-08-20 04:02:03
@article{5262234c-dabe-4266-b29c-332ef1201834,
  abstract     = {<p>OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.</p><p>METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.</p><p>RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 (P &lt; 0.001). Chest pain was present in 85% of patients, 24% were hypotensive on presentation and 28% had malperfusion syndrome. Open distal anastomosis technique under hypothermic circulatory arrest was used in 85% of cases and its use increased significantly throughout the study. The 30-day mortality decreased from 24% in 2005 to 13% in 2014 (P = 0.003). Independent predictors for 30-day mortality were preoperative cardiac arrest, malperfusion syndrome, Penn Class C, Penn Class B and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival.</p><p>CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year of operation and increased the number of operations performed per year, indicating that cumulative surgical experience contributes significantly to improved surgical outcomes.</p>},
  author       = {Geirsson, Arnar and Ahlsson, Anders and Franco-Cereceda, Anders and Fuglsang, Simon and Gunn, Jarmo and Hansson, Emma C and Hjortdal, Vibeke and Jarvela, Kati and Jeppsson, Anders and Mennander, Ari and Nozohoor, Shahab and Olsson, Christian and Pan, Emily and Wickbom, Anders and Zindovic, Igor and Gudbjartsson, Tomas},
  issn         = {1010-7940},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {276--281},
  publisher    = {Oxford University Press},
  series       = {European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery},
  title        = {Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection},
  url          = {http://dx.doi.org/10.1093/ejcts/ezx231},
  doi          = {10.1093/ejcts/ezx231},
  volume       = {53},
  year         = {2018},
}