Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection.
OBJECTIVE
The complexity of surgical treatment for acute type A dissection contributes to the variability in patient management. This study was designed to elucidate the contemporary practice preferences of cardiac surgeons regarding different phases of management of acute type A aortic dissection.


METHODS
A 34-item questionnaire was distributed to all Canadian adult cardiac surgeons addressing the preoperative, intraoperative, and postoperative management of acute type A dissection. A total of 100 responses were obtained (82% of active surgeons in Canada). Outcomes were compared between high- and low-volume aortic surgeons.


RESULTS
Seventy-six percent of respondents favored axillary artery cannulation. High-volume surgeons (>150 cases) were more likely to indicate a target lowest nasopharyngeal temperature more than 20 °C (53% vs 25%, P = .02). The majority of surgeons (65%) recommended using selective antegrade cerebral perfusion, with a significantly greater proportion for higher-volume aortic surgeons (P = .03). In addition, high-volume aortic surgeons were more likely to recommend aortic root replacement at smaller diameters (73% vs 55%, P = .02), to recommend more extensive distal aortic resection with routine open hemiarch anastomosis (85% vs 65%, P = .04), and to more commonly perform total arch reconstruction when needed (93% vs 77%, P = .04). In the follow-up period, frequency of serial imaging of the residual aorta was significantly higher for high-volume aortic surgeons (P = .04).


CONCLUSIONS
This study identified some commonalities in practice preferences among Canadian cardiac surgeons for the management of acute type A aortic dissection. However, it also highlighted significant differences in temperature management, cerebral protection strategies, and extent of resection between high-volume and low-volume aortic surgeons.
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: petersonm@smh.ca.
Mark D
MD
Peterson
Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
Amine
A
Mazine
Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
Ismail
I
El-Hamamsy
Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Cedric
C
Manlhiot
Division of Cardiac Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
Maral
M
Ouzounian
Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
Roderick G G
RG
MacArthur
Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Jeremy R
JR
Wood
Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
John
J
Bozinovski
Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
Jehangir
J
Apoo
Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
Michael C
MC
Moon
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Munir
M
Boodhwani
Division of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
Ansar
A
Hassan
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Subodh
S
Verma
Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
Francois
F
Dagenais
Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
Michael W A
MW
Chu
D000208:Acute Disease; D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000601:surgery*; D002170:Canada; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures / Q000379:methods*
aortic dissection; cerebral perfusion; hypothermic circulatory arrest; survey