Lin Ting-Wei, Tsai Meng-Ta, Wu Hsuan-Yin, Wang Yi-Chen, Hu Yu-Ning, Kan Chung-Dann, Roan Jun-Neng, Luo Chwan-Yau
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiovascular Surgery, Department of Surgery, E-DA Hospital and College of Medicine, I-Shou University, Kaohsiung, Taiwan.
JTCVS Open. 2021 Mar 18;6:1-10. doi: 10.1016/j.xjon.2021.03.006. eCollection 2021 Jun.
Surgical outcomes of acute type A aortic dissection have been recognized to be associated with the surgical volume of individual hospitals and surgeons. In this study, we aimed to investigate the results and learning curves of acute type A aortic dissection operations performed by early-career cardiovascular surgeons.
A total of 248 surgical repairs of acute type A aortic dissections were conducted at a tertiary medical center between 2010 and 2018. By using the cumulative sum test, cardiovascular surgeons in their early career were identified, and their performances were assessed. The outcomes of patients who were operated by early-career cardiovascular surgeons were compared with those by experienced or senior surgeons.
During the study period, 202 (81.5%) of the 248 acute type A aortic dissection operations were performed primarily by the 4 newly appointed attending cardiovascular surgeons. In cumulative sum curves, all surgeons exhibited a steady performance throughout the study period. On the basis of our institutional result of acute type A aortic dissection operation, early career was defined as performing fewer than 32 acute type A aortic dissection operations. The 30-day mortality rates of acute type A aortic dissection operations performed by early-career surgeons were equivalent to those performed by experienced/senior surgeons (10.9% vs 12.5%, = .844). There was also no difference in mid-term overall survival and aortic event-free survival between the 2 groups ( = .638 and = .574, respectively).
In a center with a well-established program, cardiovascular surgeons could accomplish surgical repair of acute type A aortic dissection with adequate early- and mid-term results from the initiation of their careers.
急性A型主动脉夹层的手术结果已被认为与各医院及外科医生的手术量有关。在本研究中，我们旨在调查早期心血管外科医生进行急性A型主动脉夹层手术的结果及学习曲线。
2010年至2018年期间，在一家三级医疗中心共进行了248例急性A型主动脉夹层手术修复。通过累积和检验，确定了早期心血管外科医生，并评估了他们的手术表现。将早期心血管外科医生手术患者的结果与经验丰富或资深外科医生手术患者的结果进行比较。
在研究期间，248例急性A型主动脉夹层手术中有202例（81.5%）主要由4位新任命的心血管主治医生完成。在累积和曲线中，所有外科医生在整个研究期间表现稳定。根据我们机构急性A型主动脉夹层手术的结果，早期职业定义为进行少于32例急性A型主动脉夹层手术。早期职业外科医生进行的急性A型主动脉夹层手术的30天死亡率与经验丰富/资深外科医生进行的手术相当（10.9%对12.5%，P = 0.844）。两组间中期总生存率和无主动脉事件生存率也无差异（分别为P = 0.638和P = 0.574）。
在一个有成熟项目的中心，心血管外科医生从职业生涯开始就能完成急性A型主动脉夹层的手术修复，且早期和中期结果良好。
