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

Article Article scientifique Article Outcomes of a Standardized Protocol on the Management of Acute Type A Aortic Dissection : A Retrospective Cohort Study eng 2025-05-13 2024-12 author Philippoz Supitchaya 0009-0005-7462-8348 Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 857340 author Adamopoulos Dionysios Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 930516 Département de médecine (DEMED) author Sologashvili Tornike Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 807807 Département de chirurgie (CHIRU) author Van Steenberghe Mathieu Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 935628 Département de chirurgie (CHIRU) author Jolou Jalal Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 649382 author Huber Christoph 0000-0001-9048-849X Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 853395 Département de chirurgie (CHIRU) author Cikirikcioglu Mustafa Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 135609 Département de chirurgie (CHIRU) 144-152 10.1055/s-0045-1809170 40359996 2325-4637 PMC12185164 https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0045-1809170 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. Acute Type A aortic dissection Aortic surgery Acute aortic syndrome Dewey 616 Dewey 617 57 Département de chirurgie 222 56 Département de médecine 221 false 1290 Recherche cardiovasculaire et de propulsion hémodynamique 1009 Aorta 12 6 b2dfce03-c3a1-4c1b-bef8-314cef6efc4d Article (Published version) Public Article_scientifique_from_europePmc.pdf 1045303 application/pdf CC BY-4.0 a9d29fc79560ed093cf0deccdf6735819e9c5386314d61bccd89e6d90e772c8e openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département de médecine

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Outcomes of a Standardized Protocol on the Management of Acute Type A Aortic Dissection : A Retrospective Cohort Study	Aorta			2024	13	65

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Philippoz, Supitchaya