Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States–style supercenter model?

Background The United States has established aortic supercenters, which have demonstrated clear improvements in the short-term and long-term outcomes after surgery on the thoracic aorta. This model of care does not exist in the United Kingdom. We have looked at our recent experience of emergency and...

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Published in:The Journal of thoracic and cardiovascular surgery 2014-10, Vol.148 (4), p.1428-1434.e1
Main Authors: Ariyaratnam, Priyadharshanan, BM, BSc (Hons), MRCS, Loubani, Mahmoud, MD, FRCS (CTh), FECTS, Griffin, Steven C., FRCS (CTh), Cowen, Michael E., FRCS (CTh), Vijayan, Ajith, FRCA, Jarvis, Martin A., FRCS (CTh), Cale, Alexander R.J., FRCS (CTh)
Format: Article
Language:English
Subjects:
Aorta, Thoracic
Aortic Diseases - mortality
Aortic Diseases - surgery
Cardiothoracic Surgery
Hospital Mortality
Humans
Middle Aged
Models, Organizational
Outcome and Process Assessment (Health Care)
Postoperative Complications - epidemiology
Retrospective Studies
Risk Factors
State Medicine
Survival Rate
United Kingdom
United States
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Summary:Background The United States has established aortic supercenters, which have demonstrated clear improvements in the short-term and long-term outcomes after surgery on the thoracic aorta. This model of care does not exist in the United Kingdom. We have looked at our recent experience of emergency and elective thoracic aortic surgery and describe and compare our operative outcomes and 10-year survival with other regional centers and supercenters worldwide. Methods This was a retrospective analysis of data collected prospectively from our cardiac database on patients who underwent surgery on the thoracic aorta (n = 318) between November 1999 and November 2012. The outcome measures were adjusted operative mortality, postoperative complications, and long-term survival. Results Type A dissection was carried out on 23.90% of the patients and 76.10% had surgery on the aortic root and thoracic aorta for nondissection. The mean age of the patients was 62.21 ± 14.1 years. The mean logistic EuroSCORE was 26 in the dissection group and 19 in the nondissection group. Hospital mortality was significantly greater ( P  
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2014.01.009