The Interdisciplinary Aortic Team: Opportunities for Collaboration in Acute Aortic Syndromes

Abstract

Interdisciplinary teams offer potential advantages over siloed care models in complex cardiovascular disease management. Consensus guidelines for aortic management have increasingly identified the interdisciplinary aortic team as a key component in delivering quality care. Acute aortic syndromes are a subset of high acuity and lethal aortic pathologies that may benefit from an interdisciplinary approach. The advantages of the interdisciplinary aortic team model in the management of acute aortic syndromes and barriers to implementation are discussed.

Keywords

interdisciplinary - multidisciplinary - aortic team - acute aortic syndrome - interventional radiology

Publication History

Article published online:
17 December 2024

• References

• 1 Jneid H, Chikwe J, Arnold SV. et al. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults with Valvular and Structural Heart Disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17 (04) e000129
• 2 Isselbacher EM, Preventza O, Hamilton Black Iii J. et al; Writing Committee Members. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80 (24) e223-e393
• 3 McClure RS, Lindsay TF, Keir M. et al. The aortic team model and collaborative decision pathways for the management of complex aortic disease: clinical practice update from the Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery/Canadian Association for Interventional Radiology. Can J Cardiol 2023; 39 (11) 1484-1498
• 4 Erbel R, Aboyans V, Boileau C. et al. [2014 ESC Guidelines on the diagnosis and treatment of aortic diseases]. Kardiol Pol 2014; 72 (12) 1169-1252
• 5 Czerny M, Pacini D, Aboyans V. et al. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2021; 59 (01) 65-73
• 6 Coylewright M, Mack MJ, Holmes Jr DR, O'Gara PT. A call for an evidence-based approach to the Heart Team for patients with severe aortic stenosis. J Am Coll Cardiol 2015; 65 (14) 1472-1480
• 7 McClure RS, Berry RF, Dagenais F. et al. The many care models to treat thoracic aortic disease in Canada: a nationwide survey of cardiac surgeons, cardiologists, interventional radiologists, and vascular surgeons. CJC Open 2021; 3 (06) 787-800
• 8 Landon BE, O'Malley AJ, Giles K, Cotterill P, Schermerhorn ML. Volume-outcome relationships and abdominal aortic aneurysm repair. Circulation 2010; 122 (13) 1290-1297
• 9 Hughes GC, Zhao Y, Rankin JS. et al. Effects of institutional volumes on operative outcomes for aortic root replacement in North America. J Thorac Cardiovasc Surg 2013; 145 (01) 166-170
• 10 Khan H, Hussain A, Chaubey S. et al. Acute aortic dissection type A: impact of aortic specialists on short and long term outcomes. J Card Surg 2021; 36 (03) 952-958
• 11 Bashir M, Harky A, Fok M. et al. Acute type A aortic dissection in the United Kingdom: surgeon volume-outcome relation. J Thorac Cardiovasc Surg 2017; 154 (02) 398-406.e1
• 12 Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med 2006; 29 (06) 351-364
• 13 Jessup RL. Interdisciplinary versus multidisciplinary care teams: do we understand the difference?. Aust Health Rev 2007; 31 (03) 330-331
• 14 Mariscalco G, Maselli D, Zanobini M. et al. Aortic centres should represent the standard of care for acute aortic syndrome. Eur J Prev Cardiol 2018; 25 (1 Suppl, Suppl): 3-14
• 15 Manunga J, Smith J, Schmidt CW. et al. Impact of a multidisciplinary acute aortic dissection program: improved outcomes with a comprehensive initial surgical repair strategy. J Vasc Surg 2022; 75 (02) 484-494.e1
• 16 Andersen ND, Ganapathi AM, Hanna JM, Williams JB, Gaca JG, Hughes GC. Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol 2014; 63 (17) 1796-1803
• 17 Andersen ND, Benrashid E, Ross AK. et al. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg 2016; 5 (03) 194-201
• 18 Guo MH, Fei LYN, Boodhwani M. Specialized thoracic aortic team is the next step in improving outcome in acute aortic dissection care. J Thorac Dis 2020; 12 (10) 6112-6114
• 19 Goldstone AB, Chiu P, Baiocchi M. et al. Interfacility transfer of Medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States. Circulation 2019; 140 (15) 1239-1250
• 20 Aggarwal B, Raymond CE, Randhawa MS. et al. Transfer metrics in patients with suspected acute aortic syndrome. Circ Cardiovasc Qual Outcomes 2014; 7 (05) 780-782
• 21 Harris KM, Strauss CE, Duval S. et al. Multidisciplinary standardized care for acute aortic dissection: design and initial outcomes of a regional care model. Circ Cardiovasc Qual Outcomes 2010; 3 (04) 424-430
• 22 Malaisrie SC, Szeto WY, Halas M. et al; AATS Clinical Practice Standards Committee: Adult Cardiac Surgery. 2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg 2021; 162 (03) 735-758.e2
• 23 Deeb GM, Williams DM, Bolling SF. et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg 1997; 64 (06) 1669-1675 , discussion 1675–1677
• 24 Yang B, Norton EL, Rosati CM. et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg 2019; 158 (03) 675-687.e4
• 25 Field ML, Kuduvalli M, Oo A. Multidisciplinary team-led management of acute Type B aortic dissection in the United Kingdom?. J R Soc Med 2011; 104 (02) 53-58
• 26 MacGillivray TE, Gleason TG, Patel HJ. et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163 (04) 1231-1249
• 27 Patel HJ, Nguyen C, Diener AC, Passow MC, Salata D, Deeb GM. Open arch reconstruction in the endovascular era: analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg 2011; 141 (06) 1417-1423
• 28 Yang B, Norton EL, Shih T. et al. Late outcomes of strategic arch resection in acute type A aortic dissection. J Thorac Cardiovasc Surg 2019; 157 (04) 1313-1321.e2
• 29 Tian C, Chen D, Zhao J. et al. Surgical treatment patterns and clinical outcomes of type B aortic dissection involving the aortic arch. J Vasc Surg 2023; 77 (04) 1016-1027.e9
• 30 McClure RS, Rommens KL, Herget EJ. et al. The aortic team model for the management of the distal arch, descending thoracic and thoracoabdominal aorta: appraisal at 3 years. Aorta (Stamford) 2023; 11 (06) 165-173
• 31 Chiu P, Sailer AM, Baiocchi M. et al. Impact of discordant views in the management of descending thoracic aortic aneurysm. Semin Thorac Cardiovasc Surg 2017; 29 (03) 283-291
• 32 Rudarakanchana N, Reeves BC, Bicknell CD, Heatley FM, Cheshire NJ, Powell JT. Treatment decisions for descending thoracic aneurysm: preferences for thoracic endovascular aneurysm repair or surveillance in a discrete choice experiment. Eur J Vasc Endovasc Surg 2014; 48 (01) 13-22
• 33 Cormican DS. Multidisciplinary teams: better together. J Cardiothorac Vasc Anesth 2023; 37 (10) 1850-1851
• 34 Batchelor WB, Anwaruddin S, Wang DD. et al. The multidisciplinary heart team in cardiovascular medicine: current role and future challenges. JACC Adv 2023; 2 (01) 100160
• 35 Vilacosta I, San Román JA, di Bartolomeo R. et al. Acute aortic syndrome revisited: JACC state-of-the-art review. J Am Coll Cardiol 2021; 78 (21) 2106-2125