A comprehensive multidisciplinary thoracic aortic program improves patient quality metrics after type A aortic dissection repair.

OBJECTIVE

To evaluate the impact of a multidisciplinary thoracic aortic program on quality care metrics among survivors of type A aortic dissection.

METHODS

In 2019 our center implemented a comprehensive multidisciplinary thoracic aortic program (MTAP) comprising aortic-trained cardiac surgeons, vascular surgeons, cardiologists, medical geneticists, and dedicated support personnel. In this study, we compared quality-care metrics for patients who underwent type A aortic dissection repair at a single academic institution in the 5 years before (2014-2018, "pre-MTAP," n = 87) and 4 years after (2019-2022, "MTAP," n = 126) the implementation of our MTAP program.

RESULTS

Process-of-care metrics were defined as postoperative clinical follow-up, aortic imaging surveillance rates, rates of appropriate genetic testing, and planned versus unplanned aortic reintervention. Patients in the MTAP cohort were more likely to undergo genetic testing (34% vs 15%, P = .002), had a greater per-year aortic surveillance imaging rate (1.3 scans vs 0.49 scans, P < .001), and more frequently followed up with a vascular surgeon (62% vs 46%, P = .022) compared with the pre-MTAP group. Additionally, fewer patients in the MTAP group had no follow-up or were lost to follow-up during the study period (25% vs 38%, P = .05). Aortic reinterventions in the MTAP group were more commonly planned at the index Type A dissection operation as part of a multistage procedure (33% vs 11%, P = .040) and were more likely performed endovascularly (91% vs 54%, P = .002). No patients in the MTAP group required emergent reintervention compared to 2 patients (7.1%) in the pre-MTAP group. No between group difference in survival was noted.

CONCLUSIONS

Establishment of an MTAP program improved clinical follow-up and diagnostic testing and allowed planned reintervention in survivors of type A aortic dissection.