Beller Jared P, Scheinerman Joshua A, Balsam Leora B, Ursomanno Patricia, DeAnda Abe
From the Division of Cardiac Surgery, New York University Langone Medical Center, New York, NY USA.
Innovations (Phila). 2015 Nov-Dec;10(6):410-5. doi: 10.1097/IMI.0000000000000212.
The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery team.
Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005-2009, N = 39) and after (2010-2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model.
This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital.
Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.
本研究旨在比较多学科主动脉外科团队成立前后急性A型主动脉夹层（ATAAD）修复手术的策略及患者预后。
2005年5月至2014年7月期间，我院有101例患者接受了ATAAD修复手术。2010年组建了专门的多学科主动脉外科团队（经验丰富的主动脉外科医生、灌注师、心脏麻醉医生、护士及放射科医生）。我们回顾性比较了该项目实施前（2005 - 2009年，N = 39）和实施后（2010 - 2014年，N = 62）患者的ATAAD修复手术结果。使用国际急性主动脉夹层注册术前预测模型计算预期手术死亡率。
本研究表明，主动脉外科项目实施后手术死亡率显著降低（30.8%对9.7%；P = 0.014）。手术技术和灌注策略的复杂性也有所增加，与呼吸相关（P < 0.0001）和肾衰竭（P = 0.034）的术后并发症减少。两组患者的基线人口统计学特征相似，国际急性主动脉夹层注册预测变量在两组间无统计学显著差异。然而，观察到的与预期的（O/E）手术死亡率比值降低了3.5倍。手术量增加了50%，大量患者直接被收治到我院主动脉中心进行ATAAD修复手术，从而避免了因从二级医院转院导致的手术延迟。
当由高手术量的多学科主动脉外科团队管理ATAAD的外科治疗时，患者预后得到改善。
