Repair of Acute Type A Aortic Dissection – Is Center Volume Associated with Worse Outcome? Insights from a Relatively Low-volume IRAD Participating Center

Introduction: Acute type A aortic dissection (ATA-AD) is associated with high mortality. There is conflicting evidence regarding the relationship between hospital volume and operative mortality following surgery for ATA-AD.

Our institution is being an International Registry of Acute Aortic Dissection (IRAD) member since it establishment in 1996. The aim of the study is to compare the operative outcome and the trend in mortality within the past 22 years of our relatively low-volume center with the general IRAD cohort.

Methods: Data on 97 patients with ATA-AD was obtained from our administrative, local IRAD and departmental STS database and was compared with 2,952 IRAD patients. Patients were included in the study if their symptoms presented within two weeks from diagnosis of aortic dissection.

Results: The study population included 59 males (60.1%) vs. 1992 (67.5%) in the IRAD group. The average age was 58±18 years comparing with 61.5±14.1 years in the IRAD cohort (p<0.05). Seventy patients (72%) were operated. Operative mortality was 23%. After division to three periods: 1996-2002, 2003-2009 and 2010-2018 the mortality rate was 28.6% 28.6% and 14.8%, respectively. In parallel time periods, the IRAD cohort mortality rate was 22%, 20% and 17% respectively.

Conclusion: For patients presenting with ATA-AD to a relatively low volume IRAD participating center, the in-hospital mortality rate is comparable to the entire IRAD cohort. There is a significant decline in in-hospital mortality within the study period.