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In-hospital Vascular Surgery Consultation Is Associated With Improved Long-term Care After Acute Type A Aortic Dissection
Amanda E. Lee, BS1, Kyle W. Stone, BS
1, Blake E. Murphy, MD
1, Scott DeRoo, MD
2, Christopher R. Burke, MD
2, Matthew C. Smith, MD MPH
1, Matthew P. Sweet, MD
1, Sara L. Zettervall, MD MPH
1.
1Division of Vascular Surgery, University of Washington, Seattle, WA, USA,
2Division of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA.
OBJECTIVES: While type A aortic dissections (TAAD) are historically managed by cardiac surgery, treatment with multidisciplinary teams has been shown to improve longitudinal care for patients with aortic disease. This study
assesses the impact of vascular surgery consultation on follow-up and long-term outcomes following treatment for acute TAAD.
METHODS: Patients treated for acute TAAD extending distal to Zone 1 from 2014-2025 were assessed. Vascular surgery evaluation was documented and the time of consultation assessed (index-hospitalization, outpatient, none). Follow-up was classified as complete, incomplete, or lost (LTF) according to the frequency of contrasted thoracoabdominal imaging, consistent with clinical practice guidelines. Demographics, operative characteristics, perioperative and long-term outcomes were compared. Genetic testing, aortic degeneration, reintervention, and follow-up were described.
RESULTS: 241 patients were included, 80% had vascular surgery consultation (70% inpatient, 30% outpatient) and 86% of consultations occurred within 1-year of index procedure. In total, 46% of patients had complete follow-up, 41% had incomplete follow-up, and 13% were LTF. Patients with complete follow-up had higher rates of complex arch repair (56% vs. 29%, p<0.001) and fewer perioperative strokes (14% vs 25%, p=0.048). Other comorbidities, anatomic characteristics, and perioperative outcomes were similar. Patients with complete follow-up were more likely to undergo genetic testing (53% vs. 18%, p<0.001) and TEVAR extension within 3 months (17% vs. 5%, p=0.002). In time-to-event analysis, complete follow-up was associated with more planned reinterventions (12% vs. 5%, p=0.002) and identified aneurysmal degeneration (32% vs. 15%, p=0.002) within 1-year of acute dissection, compared to incomplete follow-up. All-cause mortality at 1-year (9.4% vs. 3.1% vs. 2.7%) and 3-years (18.8% vs. 5.1% vs. 8.1%) differed by completeness of follow-up (Figure I, p=0.021). There were no aortic-related deaths for patients with complete follow-up. In-hospital vascular surgery consultation (HR 2.87, 95% CI 1.6-5.1) was associated with complete follow-up.
CONCLUSIONS: Vascular surgery consultation is associated with improved long-term follow-up, increased identification of aneurysmal degeneration, planned reinterventions, and mid-term survival. These data suggest in-hospital vascular surgery involvement is an important component of care following acute TAAD and should be strongly considered to ensure appropriate postoperative surveillance and improve patient outcomes.
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