Surgeons Learning Curve in Acute Type A Aortic Dissection

Background: Type A aortic dissection is one of the main emergency indications for cardiovascular surgery oftentimes operated on after regular working hours by the on-call surgeon. Due to its heterogeneity in presentation and surgical strategy involved it is regarded as a challenge especially for surgeons with less operative experience. The aim of this study is to investigate the influence of operative experience on outcome.

Method: All emergency surgeries for acute type A aortic dissection between January 2010 and December 2020 at a single institution were included. Operative details and outcomes of 12 surgeons (with specialty in cardiac surgery and at least 1 year of working period in the centers’ operating team) were analyzed. Analyses were stratified according to the surgeons’ operative experience (surgeons’ allocation were blinded and randomized for all analyses). Outcomes included early mortality (30 days or in-house), early complications, and aortic reoperations during follow-up.

Results: A total of 250 patients were operated on. Surgeons were stratified according to their operative experience at the time of the operation. Surgeons with up to 5 years of operative experience did not perform any extended arch procedures compared with 26% (N = 11) of surgeons with more than 20 years of operative experience (p < 0.05 inter-group significance). Time on cardiopulmonary bypass and aortic cross-clamp periods gradually decreased for surgeons in their first year up to 20 years of experience (from 184 ± 34 and 115 ± 37 minutes to 129 ± 35 and 69 ± 24 minutes, respectively; p < 0.05). No early deaths were observed for patients operated by surgeons in their first year. A peak in early mortality was observed for surgeons between their second to fifth year (20.8%, N = 5), reaching a plateau thereafter at 15.3% (N = 33; p < 0.05).

Conclusion: Surgeons in their first year of type A aortic dissection surgery did not negatively influence outcome. The second to fifth years seem to be the most vulnerable time frame with regard to operative complications. Individual attributes might also have an important effect on outcome irrespective of mere operative experience. These results might indicate the importance of a functioning aortic team supervising the early operative learning curve.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023