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General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 32–36 | Cite as

Decoding the volume–outcome relationship in Type A aortic dissection

  • Athanasios Antoniou
  • Mohamad BashirEmail author
  • Amer Harky
  • Benjamin Adams
  • Rakesh Uppal
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta
  • 113 Downloads

Abstract

Over the past few decades, the advents in monitoring, imaging, diagnostics, and implementation of multidisciplinary team approach in Type A aortic dissection surgery resulted in improved surgical outcomes. One other factor that needed to be targeted and carefully analyzed was the volume–outcome relationship on hospital and surgeon level in the settings of Type A dissection. This surely sprung form reports which indicated that supercenters providing aortic services with concentrated expert and expertise were performing better than smaller centers. We dwell in this article on the body of evidence to support concentration of experts and the effect of this organization on volume, referral, and outcome in Type A aortic dissection.

Keywords

Volume–outcome relationship Aortic dissection Aortic surgeon Aortic center 

Notes

Funding

No source of funding obtained for this study.

Compliance with ethical standards

Conflict of interest

All the authors disclose no conflict of interests.

Ethical approval

No ethical approval required for this study.

References

  1. 1.
    Olson C, Thelin S, Stahle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 1400 cases from 1987 to 2002. Circulation. 2006;114:2611–8.CrossRefGoogle Scholar
  2. 2.
    Meszaros I, Szlavi J, Morocz J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271–8.CrossRefGoogle Scholar
  3. 3.
    Bonser RS, Raanasinghe AM, Loubani M, Evans JD, Thalji NMA, Bachet JE, et al. Evidence, lack of evidence, controversy, and database in the provision and performance of the surgery of acute Type A aortic dissection. J Am Coll Cardiol. 2011;58:2455–74.CrossRefGoogle Scholar
  4. 4.
    ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM. Guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010:121: e266–369.Google Scholar
  5. 5.
    Bashir M, Harky A, Fok M, Shaw M, Hickey G, Grant S, Uppal R, Oo A. Acute Type A aortic dissection in the United Kingdom: surgeon volume-outcome relation. J Thorac Cardiovasc Surg. 2017;154(2):398–406.CrossRefGoogle Scholar
  6. 6.
    Ranasinghe AM, Strong D, Boland B, Bonser RS. Acute aortic dissection. BMJ.2011; 343: d4487.Google Scholar
  7. 7.
    Knipp BS, Depp GM, Prager RL, Williams CY, Upchurch GR, Patel HJ. A contemporary analysis of outcomes for operative repair of Type A aortic dissection in the United States. Surgery. 2007;142:524–8.CrossRefGoogle Scholar
  8. 8.
    Ckikwe J, Cavallaro P, Itagaki S, Seigerman M, DiLuzzo G, Adams DH. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality. Ann Thorac Surg. 2013;95:1563–9.CrossRefGoogle Scholar
  9. 9.
    Trimachi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, on behalf of the Interna-tional Registry of Acute Aortic Dissection Investigators et al. Contemporary results of surgery in acute Type A aortic dissection. The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 2005;129:112 – 22.CrossRefGoogle Scholar
  10. 10.
    Bridgewater B, Keogh B, Kinsman R, Wallon P. Sixth national adult cardiac surgical database report. London: Society for Cardiothoracic Surgery in UK and Ireland and Dendrite Clinical Systems Ltd; 2008.Google Scholar
  11. 11.
    Kruger T, Conzelmann LO, Bonser RS, Borger MA, Czerny M, Wildhirt S, et al. Acute aortic dissection Type A. Br J Surg. 2012;99:1331–44.CrossRefGoogle Scholar
  12. 12.
    Andersen ND, Ganapathi AM, Hanna JM, Williams JB, Gaca JG, Hughes GC. Outcomes of acute type A dissection before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol. 2014;63:1796 – 803.CrossRefGoogle Scholar
  13. 13.
    Williams JB, Phillips- Bute B, Bhattacharya SD, et al. Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg. 2011;141:1283–8.CrossRefGoogle Scholar
  14. 14.
    Andersen ND, Bhattacharya SD, Williams JB, et al. Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations. Ann Thorac Surg. 2012;234:336–42.Google Scholar
  15. 15.
    Preventza O. In type A aortic dissection repair, an effective team approach and relational coordination are more important for patients’ outcomes than surgeon volume. J Thorac Cardiovasc Surg. 2017;154 (2):407–8.CrossRefGoogle Scholar
  16. 16.
    Davies MG, Younes HK, Harris PW, Masud F, Croft BA, Reardon MJ, Lumsden AB. Outcomes before and after initiation of an acute aortic treatment center. J Vasc Surg. 2010; 52 (6): 1478–85.CrossRefGoogle Scholar
  17. 17.
    Harris KM, Strauss CE, Duval S, Unger BT, Kroshus TJ, et al. Multidisciplinary standardized care for acute aortic dissection: design and initial outcomes of a regional care model. Circ Cardiovasc Qual Outcomes. 2010;3(4):424–30.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  • Athanasios Antoniou
    • 1
  • Mohamad Bashir
    • 1
    Email author
  • Amer Harky
    • 1
  • Benjamin Adams
    • 1
  • Rakesh Uppal
    • 1
  1. 1.Department of Cardiac Surgery, Barts Heart CentreSt Bartholomew’s HospitalLondonUK

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