TY - JOUR
T1 - Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection
AU - Canadian Thoracic Aortic Collaborative Investigators
AU - Peterson, Mark D.
AU - Mazine, Amine
AU - El-Hamamsy, Ismail
AU - Manlhiot, Cedric
AU - Ouzounian, Maral
AU - MacArthur, Roderick G.G.
AU - Wood, Jeremy R.
AU - Bozinovski, John
AU - Apoo, Jehangir
AU - Moon, Michael C.
AU - Boodhwani, Munir
AU - Hassan, Ansar
AU - Verma, Subodh
AU - Dagenais, Francois
AU - Chu, Michael W.A.
AU - Poirier, Nancy
AU - Cartier, Raymond
AU - Demers, Philippe
AU - Lachapelle, Kevin
AU - Dumont, Éric
AU - Bhatnagar, Gopal
AU - Moussa, Fuad
AU - Bonneau, Daniel
AU - McClure, Scott
AU - Salasidis, Gary
AU - Guo, Ray
AU - Pozeg, Zlatko
AU - Tsang, John
AU - Wong, Daniel
N1 - Publisher Copyright:
© 2015 The American Association for Thoracic Surgery.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Objectives The complexity of surgical treatment for acute type A dissection contributes to the variability in patient management. This study was designed to elucidate the contemporary practice preferences of cardiac surgeons regarding different phases of management of acute type A aortic dissection. Methods A 34-item questionnaire was distributed to all Canadian adult cardiac surgeons addressing the preoperative, intraoperative, and postoperative management of acute type A dissection. A total of 100 responses were obtained (82% of active surgeons in Canada). Outcomes were compared between high- and low-volume aortic surgeons. Results Seventy-six percent of respondents favored axillary artery cannulation. High-volume surgeons (>150 cases) were more likely to indicate a target lowest nasopharyngeal temperature more than 20°C (53% vs 25%, P =.02). The majority of surgeons (65%) recommended using selective antegrade cerebral perfusion, with a significantly greater proportion for higher-volume aortic surgeons (P =.03). In addition, high-volume aortic surgeons were more likely to recommend aortic root replacement at smaller diameters (73% vs 55%, P =.02), to recommend more extensive distal aortic resection with routine open hemiarch anastomosis (85% vs 65%, P =.04), and to more commonly perform total arch reconstruction when needed (93% vs 77%, P =.04). In the follow-up period, frequency of serial imaging of the residual aorta was significantly higher for high-volume aortic surgeons (P =.04). Conclusions This study identified some commonalities in practice preferences among Canadian cardiac surgeons for the management of acute type A aortic dissection. However, it also highlighted significant differences in temperature management, cerebral protection strategies, and extent of resection between high-volume and low-volume aortic surgeons.
AB - Objectives The complexity of surgical treatment for acute type A dissection contributes to the variability in patient management. This study was designed to elucidate the contemporary practice preferences of cardiac surgeons regarding different phases of management of acute type A aortic dissection. Methods A 34-item questionnaire was distributed to all Canadian adult cardiac surgeons addressing the preoperative, intraoperative, and postoperative management of acute type A dissection. A total of 100 responses were obtained (82% of active surgeons in Canada). Outcomes were compared between high- and low-volume aortic surgeons. Results Seventy-six percent of respondents favored axillary artery cannulation. High-volume surgeons (>150 cases) were more likely to indicate a target lowest nasopharyngeal temperature more than 20°C (53% vs 25%, P =.02). The majority of surgeons (65%) recommended using selective antegrade cerebral perfusion, with a significantly greater proportion for higher-volume aortic surgeons (P =.03). In addition, high-volume aortic surgeons were more likely to recommend aortic root replacement at smaller diameters (73% vs 55%, P =.02), to recommend more extensive distal aortic resection with routine open hemiarch anastomosis (85% vs 65%, P =.04), and to more commonly perform total arch reconstruction when needed (93% vs 77%, P =.04). In the follow-up period, frequency of serial imaging of the residual aorta was significantly higher for high-volume aortic surgeons (P =.04). Conclusions This study identified some commonalities in practice preferences among Canadian cardiac surgeons for the management of acute type A aortic dissection. However, it also highlighted significant differences in temperature management, cerebral protection strategies, and extent of resection between high-volume and low-volume aortic surgeons.
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U2 - 10.1016/j.jtcvs.2015.07.026
DO - 10.1016/j.jtcvs.2015.07.026
M3 - Article
C2 - 26277466
AN - SCOPUS:84942838022
SN - 0022-5223
VL - 150
SP - 824-831.e5
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -