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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; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Pan, Emily; Wickbom, Anders; Zindovic, Igor; Gudbjartsson, Tomas.
Afiliación
  • Geirsson A; Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
  • Ahlsson A; Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA.
  • Franco-Cereceda A; Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, School of Health and Medicine, Orebro University, Orebro, Sweden.
  • Fuglsang S; Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
  • Gunn J; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
  • Hansson EC; Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
  • Hjortdal V; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Jarvela K; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Jeppsson A; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
  • Mennander A; Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
  • Nozohoor S; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Olsson C; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Pan E; Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
  • Wickbom A; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
  • Zindovic I; Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
  • Gudbjartsson T; Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
Eur J Cardiothorac Surg ; 53(1): 276-281, 2018 Jan 01.
Article en En | MEDLINE | ID: mdl-28977415
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aorta / Aneurisma de la Aorta / Mortalidad Hospitalaria / Hospitales de Alto Volumen / Hospitales de Bajo Volumen / Disección Aórtica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Islandia Pais de publicación: Alemania
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aorta / Aneurisma de la Aorta / Mortalidad Hospitalaria / Hospitales de Alto Volumen / Hospitales de Bajo Volumen / Disección Aórtica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Islandia Pais de publicación: Alemania