Objective

This is the largest UK study to compare outcomes before and after implementation of a dedicated specialist aortovascular service (AVS) for the management of acute aortic dissection (AAD).

Methods

Outcomes were analysed for 266 consecutive patients with acute aortic dissection undergoing surgical repair between 2004-2015. 141 (53%) were in the period prior to institution of an AVS and 125 (47%) were in the period after. Primary outcome measure was in-hospital mortality. Secondary outcome measures were mid-term survival and morbidity.

Results

In-hospital mortality reduced from 25% to 14% (P<0.01). Kaplan Meier survival at 36-months increased from 70% to 83.2% (P<0.01). The composite secondary end-point (stroke, paraplegia, renal failure, ITU stay>7days and multi-system organ dysfunction) reduced from 23.4% to 18% (P<0.05). More complex operations were performed with shorter cardiopulmonary bypass (181 ± 65vs.161.3 ± 62, P<0.05) and cross-clamp times (±38 vs. 75±28, P<0.05).

Conclusion

AVS surgeons utilised hypothermic circulatory arrest and hemiarch/total arch replacement as standard of care. This in the setting of shorter operative times and might help explain reduced in-hospital mortality, decreased morbidity and improved midterm outcomes. There were improvements in the patient care pathway with reduction in time from diagnosis to surgery. Our study provides strong evidence for the centralization of AAD management.