Impact of an on-call specialist aortic rota implementation in acute type a aortic dissection on outcomes and repair complexity: A retrospective cohort study
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Pruna-Guillen, Robert
Rojanathagoon, Thanakorn
Oo, Aung
Adams, Benjamin
Lall, Kulvinder
Yap, John
Di Salvo, Carmelo
Uppal, Rakesh
Lopez-Marco, Ana
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2025
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Article
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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 = 0.049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (p = 0.033). Group B had a higher rate of aortic root replacement (44% vs. 35%, p = 0.008), lower ascending aorta and hemiarch replacement (40% vs. 53%, p = 0.013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs. 20%, p = 0.139) and frozen elephant trunk (20% vs. 14%, p = 0.171). Postoperative complications, including permanent stroke (7.9% vs. 9.3%, p = 0.250) and continuous renal replacement therapy (9.8% vs. 12.3%, p = 0.196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs. 9.7%, p = 0.036). CONCLUSION: 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.
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Interdisciplinary cardiovascular and thoracic surgery
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2