title: Aortic Root Surgery: Does High Surgical Volume and a Consistent Perioperative Approach Improve Outcome?
abstract: There is evidence that high surgical volume and team consistency improve outcomes. Mortality of 4%-12% for aortic root surgery has been reported in the United States and UK. We aim to assess outcomes of patients undergoing aortic root surgery by a consistent, high-volume team. Data on patients undergoing elective or urgent aortic root replacement (ARR) were collected prospectively. Patients undergoing emergency surgery were excluded. A standardized perioperative approach was maintained and was achieved by delivering training to team members, including surgical trainees, anesthetic, nursing, and perfusion staff, whenever there was a change of team. Between 2005 and 2014, 344 patients underwent ARR. Median age was 59 years (18-86) and 74% were men. Procedures included ARR (biological [186; 54%] or mechanical [101; 29.4%]) and valve sparing root replacement, remodeling technique (57; 16.6%). A total of 42 patients (12.2%) underwent concomitant procedures. There were 4 (1.2%) in-hospital deaths and no incidence of stroke. In total, 3 (0.9%) required resternotomy for bleeding and 8 (2.3%) required hemofiltration. Follow-up was complete for 94% of patients with median intensive care unit and hospital stays of 1 and 6 days, respectively. Follow-up was complete for 94% of patients at a median of 5.6 years with 98% freedom from reoperation and prosthetic valve dysfunction. There was 90% freedom from aortic insufficiency at 7 years in the valve sparing root replacement, remodeling technique cohort. We have demonstrated that high surgical volume and standardized care improves outcomes in aortic root surgery. Maintaining a consistent perioperative approach ensures team members are aware and well rehearsed in their roles, thereby improving outcomes.
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Rajdeep
authors.initials: R
authors.lastname: Bilkhu
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Pouya
authors.initials: P
authors.lastname: Youssefi
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Gopal
authors.initials: G
authors.lastname: Soppa
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Child
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Edsell
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: van Besouw
authors.affiliation: Departments of Cardiothoracic Surgery, Cardiology and Anesthesia, St. George׳s Hospital, London, UK. Electronic address: marjan.jahangiri@stgeorges.nhs.uk.
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000592:standards; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D006440:Hemofiltration; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008131:London; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017064:Process Assessment, Health Care / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: aortic root; aortic root replacement; outcomes; training