title: Operative Strategies and Outcomes in Type A Aortic Dissection After the Enactment of a Multidisciplinary Aortic Surgery Team.
abstract: OBJECTIVE
  The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery team.
  
  
  METHODS
  Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005-2009, N = 39) and after (2010-2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model.
  
  
  RESULTS
  This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital.
  
  
  CONCLUSIONS
  Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.
authors.affiliation: From the Division of Cardiac Surgery, New York University Langone Medical Center, New York, NY USA.
authors.forename: Jared P
authors.initials: JP
authors.lastname: Beller
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Scheinerman
authors.forename: Leora B
authors.initials: LB
authors.lastname: Balsam
authors.forename: Patricia
authors.initials: P
authors.lastname: Ursomanno
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009518:New York / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000592:standards; D016019:Survival Analysis; D016896:Treatment Outcome