Regionalization of Aortic Arch Surgery in Chile: Resource Optimization and Clinical Outcomes in a High-Volume Center.

UNLABELLED: Acute aortic syndrome (AAS), particularly acute type A aortic dissection (ATAAD), carries extremely high mortality without prompt surgical intervention. In Chile, structural barriers and uneven healthcare distribution hinder timely treatment. In 2023, a specialized aortic program was implemented at Hospital Las Higueras, Talcahuano, to centralize expertise and optimize outcomes, including complex procedures such as aortic arch surgery.

AIM: To evaluate the feasibility and clinical impact of a regionalized aortic program in Chile, focusing on morbidity, mortality, follow-up, and outcomes of aortic arch surgery.

METHODS

A retrospective, descriptive study including all patients undergoing surgery for ATAAD and aortic arch replacement from 2011 to 2024. Outcomes before program implementation (2011-2022) were compared with those after implementation (2023-2024). Primary endpoints were in-hospital and 30-day mortality; secondary endpoints included postoperative complications and follow-up adherence.

RESULTS

Of 4,531 major cardiac surgeries, 83 involved ATAAD (44 pre-program, 39 post-program). Mortality decreased from 44% before the program to 15.4% after. Aortic arch procedures increased from 5 to 22, with all-cause mortality declining from 60% to 27.3%. No elective deaths occurred after program implementation. Acute kidney injury was observed in 59.1%, with only one patient requiring temporary dialysis; no cases of paraplegia were recorded. Structured follow-up retained 95% of patients, enabling early detection of complications and timely elective reinterventions.

CONCLUSIONS

Establishing a dedicated aortic program in a regional high-volume center significantly improved survival and increased elective case detection. The structured management of aortic arch surgery within this framework further reinforced the benefits of centralization, showing improved safety in elective settings. Centralization of resources, multidisciplinary coordination, and structured follow-up are feasible strategies to enhance outcomes in countries with limited resources and geographic barriers.