title: Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas.
abstract: Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers. We compared the outcomes of surgery for TAAD in high-volume (HV) and LV centers in a single metropolitan area to determine the optimal setting for treatment. Thirty-five of the 37 cardiac surgery programs in the Dallas Ft. Worth metropolitan area participate in a regional consortium to measure outcomes collected in the Society of Thoracic Surgeons Adult Cardiac Database. From January 01, 2008, to December 31, 2014, 29 programs had treated TAAD. Those programs performing at least 100 operations for TAAD were considered HV centers and the others LV. Surgery for TAAD was performed in 672 patients over the 7-year study period with HV centers performing 469 of 672 (70%) of the operations. Despite similar preoperative characteristics, operative mortality was significantly lower in HV versus LV centers (14.1% vs 24.1%; p = 0.001). There was no significant difference in postoperative paralysis rates (2.6% vs 4.5%; p = 0.196), stroke rates (10.7% vs 9.4%; p = 0.623), or 30-day readmission rates (12.1% vs 15.5%; p = 0.292). An improved survival rate in HV centers was maintained over a 5-year follow-up period. Surgery for TAAD in a single large metropolitan area was most commonly performed in HV centers. In conclusion, the treatment of acute thoracic aortic dissection is recommended to be performed in reference centers because of lower early and midterm mortality.
authors.affiliation: Department Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Baylor Research Institute, Dallas, Texas.
authors.forename: Mani
authors.initials: M
authors.lastname: Arsalan
authors.affiliation: Baylor Research Institute, Dallas, Texas.
authors.forename: John J
authors.initials: JJ
authors.lastname: Squiers
authors.affiliation: Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Morley A
authors.initials: MA
authors.lastname: Herbert
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, Texas.
authors.forename: Juan C
authors.initials: JC
authors.lastname: MacHannaford
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, Texas.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
authors.affiliation: Texas Quality Initiative, Dallas Fort Worth Hospital Council Foundation, Irving, Texas.
authors.forename: Syma L
authors.initials: SL
authors.lastname: Prince
authors.affiliation: Texas Quality Initiative, Dallas Fort Worth Hospital Council Foundation, Irving, Texas.
authors.forename: Baron L
authors.initials: BL
authors.lastname: Hamman
authors.affiliation: Texas Quality Initiative, Dallas Fort Worth Hospital Council Foundation, Irving, Texas.
authors.forename: Cathy
authors.initials: C
authors.lastname: Knoff
authors.affiliation: Department of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: David O
authors.initials: DO
authors.lastname: Moore
authors.affiliation: Department of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Harrington
authors.affiliation: Baylor Research Institute, Dallas, Texas.
authors.forename: J Michael
authors.initials: JM
authors.lastname: DiMaio
authors.affiliation: Department of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Department of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Texas. Electronic address: William.Brinkman@BSWHealth.org.
authors.forename: William T
authors.initials: WT
authors.lastname: Brinkman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome