Increasing complexity in aortic dissection reduces complications, improves outcomes—but mortality remains constant

When it comes to type A aortic dissection, cardiac surgeons have increasingly opted to perform more complex operations to reduce complications and improve postoperative care.

A study, published online June 6 in The Annals of Thoracic Surgery, examined cardiac surgeries from 2003 to 2015 to examine the association between a procedure’s complexity and risks faced by the patient.

“Type A aortic dissection requires emergency surgical repair,” said senior author Ravi K. Ghanta, MD, formerly of the University of Virginia in Charlottesville, now with Baylor College of Medicine in Houston. “This study shows that surgeons are adapting their surgical strategies to more aggressively treat aortic dissections, surprisingly, without additional upfront risk. Therefore, patients are benefiting from more extensive repair of aortic dissection, which may lead to improved long-term outcomes.”

For this study, Ghanta and colleagues reviewed records for 884 patients who underwent operations for acute type A aortic dissection from 2003 to 2015 in Virginia. Patients were grouped by when they underwent aortic dissection (309 were in the 2003-2009 group, 316 in 2009-2012 and 259 in 2013-2015). The median age of patients was 59 years.

Results showed the operations grew in complexity over time. Aortic root surgery (16 percent, 39 percent and 67 percent, respectively) and aortic arch repair (27 percent, 26 percent and 36 percent, respectively) were more common in the latest group.

Still, the mortality risk remained constant, at 19 percent, though risks for pneumonia and reoperation were significantly lowered.

“Surgeons are increasingly comfortable with performing more extensive repairs of the aorta and utilizing new surgical techniques, and they are doing so without increasing risk,” Ghanta said. “However, while the operative mortality numbers are lower than historical outcomes, 19 percent is still significant and further improvement is needed.”

""
Nicholas Leider, Managing Editor

Nicholas joined TriMed in 2016 as the managing editor of the Chicago office. After receiving his master’s from Roosevelt University, he worked in various writing/editing roles for magazines ranging in topic from billiards to metallurgy. Currently on Chicago’s north side, Nicholas keeps busy by running, reading and talking to his two cats.

Around the web

Cardiovascular devices are more likely to be in a Class I recall than any other device type. The FDA's approval process appears to be at least partially responsible, though the agency is working to make some serious changes. We spoke to a researcher who has been tracking these data for years to learn more. 

Updated compensation data includes good news for multiple subspecialties. The new report also examines private equity's impact on employment models and how much male cardiologists earn compared to females.

When drugs are on the FDA’s shortage list, outsourcing facilities can produce their own compounded versions. When the FDA removed tirzepatide from that list with no warning, it created a considerable amount of chaos both behind the scenes and in pharmacies all over the country. 

Trimed Popup
Trimed Popup