Aortic centres should represent the standard of care for acute aortic syndrome

Giovanni Mariscalco, Daniele Maselli, Marco Zanobini, Aamer Ahmed, Vito D. Bruno, Umberto Benedetto, Riccardo Gherli, Tiziano Gherli, Francesco Nicolini

Research output: Contribution to journalArticle

Abstract

Background: Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods: The design was a quantitative and qualitative review of observational studies. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results: A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). Conclusions: We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.

Original languageEnglish
Pages (from-to)3-14
Number of pages12
JournalEuropean Journal of Preventive Cardiology
Volume25
Issue number1_suppl
DOIs
Publication statusPublished - Jun 1 2018

Keywords

  • Acute aortic syndrome
  • aortic dissections
  • hospital volume
  • meta-analysis
  • quality of health care
  • surgeon volume

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Mariscalco, G., Maselli, D., Zanobini, M., Ahmed, A., Bruno, V. D., Benedetto, U., Gherli, R., Gherli, T., & Nicolini, F. (2018). Aortic centres should represent the standard of care for acute aortic syndrome. European Journal of Preventive Cardiology, 25(1_suppl), 3-14. https://doi.org/10.1177/2047487318764963