Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK.
Eur J Cardiothorac Surg. 2019 May 1;55(5):984-989. doi: 10.1093/ejcts/ezy386.
Acute type A aortic dissection is an emergency associated with up to 30% of hospital mortality. It has been established that outcomes are improved with specialist aortic team care in high-volume centres. Most centres are limited to a small number of aortic specialists, thus making it logistically impractical to have a dedicated 24/7 single-centre service. In 2011, a rotational 24/7 service between 3 centres covering a geographical location was introduced including 24/7 access to a dissection 'Hotline'.
We analysed data since 2003 from a prospectively collected database. A total of 227 patients underwent surgery for acute aortic syndrome between 2003 and 2017. The results on outcomes were compared before and after the initiation of the dissection hotline and 24/7 dedicated service.
We identified 128 patients from the pre-rotational group and 99 patients from the post-rotational group. Both groups were well matched in terms of demographics and comorbidities. In the post-rotational group, there was an increase in arch surgery (11.8% vs 20.2%, P: 0.07). The introduction of the rotational service reduced 30-day mortality (20% vs 8%, P: 0.010). The introduction of the service improved the overall long-term survival [P: 0.04, hazard ratio 1.86; confidence interval (1.03-3.38)] in the multivariable analysis. There was no difference between the groups in postoperative complications. There was an increase in the median length of hospital stay in the post-rotational group (13 days vs 20 days, P: 0.014).
A streamlined aortic dissection service allows for centralized care. This provides the referring centres with 24/7 access to an experienced aortic team and may improve patient outcomes.
急性 A 型主动脉夹层是一种与高达 30%的医院死亡率相关的急症。已经证实，在高容量中心，由专业的主动脉团队提供治疗可以改善预后。大多数中心都受到少数主动脉专家的限制，因此，在一个中心建立一个专门的 24/7 服务在后勤上是不切实际的。2011 年，引入了一种由三个中心轮流提供的 24/7 服务，该服务包括 24/7 访问夹层“热线”。
我们分析了 2003 年以来前瞻性收集的数据库中的数据。共有 227 例急性主动脉综合征患者在 2003 年至 2017 年期间接受了手术治疗。我们比较了在引入夹层热线和 24/7 专用服务前后的结果。
我们从旋转前组中确定了 128 例患者，从旋转后组中确定了 99 例患者。两组在人口统计学和合并症方面匹配良好。在旋转后组中，弓部手术的比例增加（11.8%对 20.2%，P=0.07）。引入旋转服务降低了 30 天死亡率（20%对 8%，P=0.010）。该服务的引入提高了总体长期生存率[P=0.04，风险比 1.86；置信区间（1.03-3.38）]，多变量分析结果显示。两组之间术后并发症无差异。旋转后组的中位住院时间延长（13 天对 20 天，P=0.014）。
简化的主动脉夹层服务允许集中护理。这为转诊中心提供了 24/7 访问经验丰富的主动脉团队的机会，并可能改善患者的预后。
