Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States-style supercenter model?

Journal of Thoracic and Cardiovascular Surgery

PubMedID: 24521962

Ariyaratnam P, Loubani M, Griffin SC, Cowen ME, Vijayan A, Jarvis MA, Cale AR. Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States-style supercenter model?. J Thorac Cardiovasc Surg. 2014;148(4):1428-1434.e1.
BACKGROUND
The United States has established aortic supercenters, which have demonstrated clear improvements in the short-term and long-term outcomes after surgery on the thoracic aorta. This model of care does not exist in the United Kingdom. We have looked at our recent experience of emergency and elective thoracic aortic surgery and describe and compare our operative outcomes and 10-year survival with other regional centers and supercenters worldwide.

METHODS
This was a retrospective analysis of data collected prospectively from our cardiac database on patients who underwent surgery on the thoracic aorta (n = 318) between November 1999 and November 2012. The outcome measures were adjusted operative mortality, postoperative complications, and long-term survival.

RESULTS
Type A dissection was carried out on 23.90% of the patients and 76.10% had surgery on the aortic root and thoracic aorta for nondissection. The mean age of the patients was 62.21 ± 14.1 years. The mean logistic EuroSCORE was 26 in the dissection group and 19 in the nondissection group. Hospital mortality was significantly greater (P < .05) in the dissection group compared with the nondissection group (23.7% vs 12.8%). Survival after dissection and nondissection surgery was 66.3% ± 5.6% versus 77.4% ± 2.8%, respectively, at 3 years, 63.9% ± 5.9% versus 71.8% ± 3.2% at 5 years, and 53.7% ± 7.4% versus 47.1% ± 6.0% at 10 years.

CONCLUSIONS
Our outcomes are comparable with other regional centers worldwide; however, they are not as good as those reported from the aortic supercenters. There should be continued impetus regarding the establishment of thoracic aortic surgery guidelines and specialist aortic centers in the United Kingdom.