Interdisciplinary cardiovascular and thoracic surgery · 2025
Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pruna-Guillen Robert, Rojanathagoon Thanakorn, Oo Aung, Adams Benjamin, Lall Kulvinder, Yap John, Di Salvo Carmelo, Uppal Rakesh, Lopez-Marco Ana
Аннотация
OBJECTIVES: Acute Type A aortic dissection (ATAAD) repair is a high-risk procedure with significant in-hospital mortality. This study evaluates the impact of implementing an On-call Specialist Aortic Rota on ATAAD repair outcomes.
METHODS: Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n = 406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups.
RESULTS: Preoperative characteristics were similar between groups (mean age 59.7 ± 14 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P = .049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P = .033). Group B had a higher rate of aortic root replacement (44% vs 35%, P = .008), lower ascending aorta and hemiarch replacement (40% vs 53%, P = .013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P = .139) and frozen elephant trunk (20% vs 14%, P = .171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P = .250) and continuous renal replacement therapy (9.8% vs 12.3%, P = .196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs 9.7%, P = .036).
CONCLUSIONS: The period after introducing an On-Call Specialist Aortic Rota was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00) and accompanied by a practice-pattern shift towards more extensive repairs. Given the observational design and potential for residual confounding and calendar-time bias, these findings should be viewed as associative rather than causal and require confirmation in multicentre studies with longer follow-up.
CLINICAL TRIAL REGISTRY NUMBER: CEU/2019/11118.
METHODS: Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n = 406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups.
RESULTS: Preoperative characteristics were similar between groups (mean age 59.7 ± 14 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P = .049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P = .033). Group B had a higher rate of aortic root replacement (44% vs 35%, P = .008), lower ascending aorta and hemiarch replacement (40% vs 53%, P = .013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P = .139) and frozen elephant trunk (20% vs 14%, P = .171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P = .250) and continuous renal replacement therapy (9.8% vs 12.3%, P = .196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs 9.7%, P = .036).
CONCLUSIONS: The period after introducing an On-Call Specialist Aortic Rota was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00) and accompanied by a practice-pattern shift towards more extensive repairs. Given the observational design and potential for residual confounding and calendar-time bias, these findings should be viewed as associative rather than causal and require confirmation in multicentre studies with longer follow-up.
CLINICAL TRIAL REGISTRY NUMBER: CEU/2019/11118.