INFLUENCE OF SURGICAL EXPERTISE ON REPAIR OF ACUTE TYPE A AORTIC DISSECTION. A PROPENSITY SCORE MATCHED ANALYSIS.

Objective: We aimed to verify whether in patients with acute type A aortic dissection the results of aortic repair are significantly influenced by surgeon expertise. Methods: 199 patients with acute type A aortic dissection were divided in two groups: those operated by expert (n=138) and those by not-expert aortic surgeons (n=61) all being members of the aortic team. Early outcomes in both groups were evaluated and compared. A propensity score matching analysis was applied to obtain two similar populations. Results: The clinical presentation was more compromised in patients operated by expert than by not-expert surgeons: 36% vs 16% being hemodynamically instable (p=0.005) and 22% vs 5% having focal neurological damage (p=0.003). Intraoperative setting was similar among the two groups, with axillary artery cannulation being almost routinely used. Expert surgeons performed more frequently arch surgery (40% vs 26%, p=0.06). Operative times were also similar with median cardiopulmonary bypass time of 203 minutes for expert and 201 minutes for not-expert surgeons, respectively (p=0.88). Median in-hospital stay was shorter for patients operated by not-expert that by expert surgeons (10 and 17 days, p=0.04). After propensity score matching, mortality was still not significantly different between expert and not-expert surgeons (5% versus 12%, p=0.43). Conclusions: Outcomes of patients with acute type A aortic dissection were satisfactory even when surgery was performed by not-expert surgeons included in an aortic team organization.