Acute Type A Dissection Repair by High versus Low Volume Surgeons at a High-Volume Aortic Center

Abstract Background Previous studies suggest improved outcomes for acute Type A dissections (ATAAD) treated at high-volume centers. It is unclear if outcomes are a result of individual surgeon experience or inherent resources available at high-volume centers. To explore this question, we stratified outcomes for ATAAD repair by low and high-volume surgeons at a high-volume center. Methods We reviewed our institutional experience with ATAAD between 1999-2016 (n=580). To evaluate surgeon experience with ATAAD repair, we categorized surgeons as high volume (HVAS, cases >10 per year) or low volume aortic surgeons (LVAS, cases Results The total experience for HVAS and LVAS as primary surgeon for the study period was 513 and 67, respectively. Mean annual experience as primary surgeon was 15.2 cases for HVAS and 3.4 cases for LVAS. In-hospital mortality was 14.0% if a HVAS was present and 24.0% with an all LVAS team (p=0.27). After adjusting for preoperative factors, the mortality odds ratio for an all LVAS team was 3.72 (p=0.01). Conclusions ATAAD repair by an all LVAS team had nearly a four-fold increase in-hospital mortality compared to an all HVAS team. Improved outcomes at high-volume centers may be predominantly due to surgeon experience and not from center-specific resources. This study may have implications on call coverage for ATAAD repair at high-volume centers.