Outcomes of a Standardized Protocol on the Management of Acute Type A Aortic Dissection: A Retrospective Cohort Study

TL;DR

A standardized protocol for treating acute Type A aortic dissection reduced reoperations and aortic dilation, improving patient outcomes compared to surgeon-dependent methods.

Contribution

Demonstrates that standardized protocols in low-volume centers can improve AAAD management by reducing reoperation and dilation rates.

Findings

Standardized protocol reduced late reoperation and aortic dilatation rates compared to surgeon-dependent techniques.

Group 2 had longer surgery and cardiopulmonary bypass times but similar overall complication rates.

Use of hypothermic circulatory arrest and cerebral perfusion increased with the standardized protocol.

Abstract

Acute Type A aortic dissection (AAAD) is a life-threatening condition, with surgery being the recommended treatment. However, there is ongoing debate regarding the optimal surgical procedure. This study aimed to evaluate the impact of implementing a standardized protocol, introduced in our institution in 2016, on AAAD management.

A retrospective cohort study was conducted involving patients treated surgically for AAAD between 2010 and 2021 in our department. Patients were divided into two groups: those who underwent surgery before 2016 using operator-dependent techniques, and those who underwent surgery starting in 2016 using a standardized protocol.

A total of 104 patients were included in this study. The mean age was 66.5 ± 11.4 years and 55.8% were male. Demographics and preoperative data were similar in both groups. Arterial and venous cannulation site of both groups were different (
p
 < 0.001): femoral artery and vein cannulation for group 1 versus subclavian artery and central venous canulation for group 2. Alone ascending aorta replacement versus ascending aorta plus hemiarch replacement were the preferred techniques in groups 1 and 2, respectively (
p
 < 0.001). Hypothermic circulatory arrest and cerebral perfusion were largely performed in group 2 compared with group 1 (
p
 < 0.001). The total time of surgery, the cardiopulmonary bypass, and aortic cross-clamping times were longer in group 2 (
p
 < 0.05). Both groups had similar rates of postoperative complications, except for late reoperation and aortic dilatation rates, which were less frequent in group 2 (
p
 < 0.05).

The implementation of a standardized institutional protocol can transform AAAD surgery from a “surgeon-tailored” to a “ patient-tailored” approach. The use of a standardized protocol in our institution resulted in a significant reduction of aortic reoperation and aortic dilation rates, suggesting that the introduction of standardized protocols in low-volume centers may improve AAAD management.

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