Objective

There is evidence that maintaining high surgical volume improves surgical outcomes. There is also evidence to show that a lack of team consistency can adversely affect outcomes. Mortality of 4-12% for aortic root surgery within the USA and UK has been reported. Maintaining team consistency may therefore be a way of improving outcomes in aortic root surgery. We report our experience of aortic root replacement (ARR) by a consistent operative team.

Methods

Prospective data on patients undergoing elective or urgent ARR between 2005 and 2014 was collected. A standardised operative approach and a standardised approach to anaesthetic and perioperative care was established. This was achieved by delivering training to team members, including surgical trainees, anaesthetic and nursing staff, whenever there was a change of team. Emergency operations were excluded as these cases tended to be out of hours, when there was not a consistent operative team.

Results

344 patients were identified. Median age was 59 years (range 18-86). 74% were men. There were 287 ARR, 57 valve sparing ARR and 42 required concomitant procedures. There were 4 (1.2%) deaths and no patients suffered a stroke. Three (0.9%) required resternotomy for bleeding and 8 (2.3%) required haemofiltration. Median ICU and hospital stays were 1 & 6 days respectively. At a median follow up of 5.6 years there was 98% freedom from reoperation and prosthetic valve dysfunction.

Conclusion

By maintaining high surgical volume and standardised care, we have demonstrated favourable outcomes in aortic root surgery. Also, by improving team consistency and ensuring that team members are aware and well rehearsed in their roles, team dynamics are enhanced and help improve outcomes of aortic root surgery.