Thorac Cardiovasc Surg 2016; 64 - OP171
DOI: 10.1055/s-0036-1571605

Hospital Volume Impacts Outcomes in the Treatment of Type A Aortic Dissection

M. Arsalan 1, 2, J. J. Squiers 3, M. A. Herbert 4, J. C. Mac Hannaford 5, T. Chamogeorgakis 5, D. O. Moore 2, K. B. Harrington 2, M. J. Mack 2, W. T. Brinkman 2
  • 1Kerckhoff Klinik, Bad Nauheim, Germany
  • 2The Heart Hospital Baylor Plano, Dallas, United States
  • 3Baylor Healthcare System, Department of Epidemiology, Dallas, United States
  • 4Medical City Dallas Hospital, Department of Clinical Research, Dallas, United States
  • 5Baylor University Medical Center, Dallas, United States

Objectives: Immediate surgery is standard therapy for acute type A aortic dissections. In-hospital mortality of TAAD after surgery is reported to be between 15–30%. This variety might be explained by the hospitals experience in the treatment of this disease as due to the low incidence, many smaller cardiac surgery programs do not routinely perform this procedure. In this study, we compared the outcome of surgery for type A aortic dissections between high (HV) and low volume (LV) centers.

Methods: Data from the Texas Quality Initiative (TQI) regional certified cardiovascular registry - STS data collected from a North Texas co-operative of 29 hospitals - were evaluated. Patient characteristics and operative mortality were analyzed, using STS definitions. Programs performing at least 100 operations during the study period were considered high volume centers.

Results: Between 01/01/2008–12/31/2014, 612 patients underwent surgery for type A aortic dissection in the participating hospitals. Only three of the participating 29 hospitals performed at least 100 operations during this period. High volume centers performed 431 operations, and low volume centers performed 181. The preoperative characteristics of the patients were very similar. While circulatory arrest with cerebral perfusion was more often performed in HV (79.7% versus 63.0%; p = 0.004), perfusion, cross-clamp and circulatory arrest times did not differ significantly between groups. Operative mortality was significantly lower in HV versus LV centers (14.4% versus 24.3%; p = 0.003), without significant difference in 30-day readmission rates (HV 11.9% versus LV 16.7%; p = 0.157), postoperative paralysis rate (HV 2.8% versus LV 5.1%; p = 0.219), or stroke rate (HV 10.7% versus LV 9.4%; p = 0.649).

Conclusions: More than two-third of all surgeries for type A aortic dissections in North Texas are performed in high volume centers. Although, there was no difference in baseline patient characteristics, surgery in these centers was associated with a 10% lower mortality rate and a trend toward lower readmission rates. The extensive experience of HV centers in managing TAAD produces excellent results compared with LV centers, supporting the notion of preferred TAAD treatment in HV centers.