Outcomes of acute type A aortic dissection operations performed by early-career cardiovascular surgeons

Ting-Wei Lin; Meng-Ta Tsai; Hsuan-Yin Wu; Yi-Chen Wang; Yu-Ning Hu; Chung-Dann Kan; Jun-Neng Roan; Chwan-Yau Luo

doi:10.1016/j.xjon.2021.03.006

Outcomes of acute type A aortic dissection operations performed by early-career cardiovascular surgeons

JTCVS Open. 2021 Mar 18:6:1-10. doi: 10.1016/j.xjon.2021.03.006. eCollection 2021 Jun.

Authors

Ting-Wei Lin^{1

2}, Meng-Ta Tsai¹, Hsuan-Yin Wu², Yi-Chen Wang¹, Yu-Ning Hu¹, Chung-Dann Kan¹, Jun-Neng Roan¹, Chwan-Yau Luo^{1

2}

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Division of Cardiovascular Surgery, Department of Surgery, E-DA Hospital and College of Medicine, I-Shou University, Kaohsiung, Taiwan.

Abstract

Objective: Surgical outcomes of acute type A aortic dissection have been recognized to be associated with the surgical volume of individual hospitals and surgeons. In this study, we aimed to investigate the results and learning curves of acute type A aortic dissection operations performed by early-career cardiovascular surgeons.

Methods: A total of 248 surgical repairs of acute type A aortic dissections were conducted at a tertiary medical center between 2010 and 2018. By using the cumulative sum test, cardiovascular surgeons in their early career were identified, and their performances were assessed. The outcomes of patients who were operated by early-career cardiovascular surgeons were compared with those by experienced or senior surgeons.

Results: During the study period, 202 (81.5%) of the 248 acute type A aortic dissection operations were performed primarily by the 4 newly appointed attending cardiovascular surgeons. In cumulative sum curves, all surgeons exhibited a steady performance throughout the study period. On the basis of our institutional result of acute type A aortic dissection operation, early career was defined as performing fewer than 32 acute type A aortic dissection operations. The 30-day mortality rates of acute type A aortic dissection operations performed by early-career surgeons were equivalent to those performed by experienced/senior surgeons (10.9% vs 12.5%, P = .844). There was also no difference in mid-term overall survival and aortic event-free survival between the 2 groups (P = .638 and P = .574, respectively).

Conclusions: In a center with a well-established program, cardiovascular surgeons could accomplish surgical repair of acute type A aortic dissection with adequate early- and mid-term results from the initiation of their careers.

Keywords: CUSUM analysis; CUSUM, cumulative sum; IRAD, International Registry of Acute Aortic Dissection; OR, odds ratio; SACP, selective antegrade cerebral perfusion; SPRT, sequential probability ratio test; aTAAD, acute type A aortic dissection; acute type A aortic dissection; early-career surgeons; outcome.