Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection

Mark D Peterson; Amine Mazine; Ismail El-Hamamsy; Cedric Manlhiot; Maral Ouzounian; Roderick G G MacArthur; Jeremy R Wood; John Bozinovski; Jehangir Apoo; Michael C Moon; Munir Boodhwani; Ansar Hassan; Subodh Verma; Francois Dagenais; Michael W A Chu; Canadian Thoracic Aortic Collaborative Investigators

doi:10.1016/j.jtcvs.2015.07.026

Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection

J Thorac Cardiovasc Surg. 2015 Oct;150(4):824-31.e1-5. doi: 10.1016/j.jtcvs.2015.07.026. Epub 2015 Jul 14.

Authors

Mark D Peterson¹, Amine Mazine², Ismail El-Hamamsy², Cedric Manlhiot³, Maral Ouzounian⁴, Roderick G G MacArthur⁵, Jeremy R Wood⁶, John Bozinovski⁷, Jehangir Apoo⁸, Michael C Moon⁵, Munir Boodhwani⁹, Ansar Hassan¹⁰, Subodh Verma¹¹, Francois Dagenais¹², Michael W A Chu¹³; Canadian Thoracic Aortic Collaborative Investigators

Collaborators

Canadian Thoracic Aortic Collaborative Investigators:
Nancy Poirier, Raymond Cartier, Philippe Demers, Kevin Lachapelle, Éric Dumont, Gopal Bhatnagar, Fuad Moussa, Daniel Bonneau, Scott McClure, Gary Salasidis, Ray Guo, Zlatko Pozeg, John Tsang, Daniel Wong

Affiliations

¹ Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: petersonm@smh.ca.
² Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
³ Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Cardiac Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
⁶ Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
⁷ Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
⁸ Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
⁹ Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹⁰ Division of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
¹¹ Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
¹² Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
¹³ Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.

PMID: 26277466
DOI: 10.1016/j.jtcvs.2015.07.026

Abstract

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.

Keywords: aortic dissection; cerebral perfusion; hypothermic circulatory arrest; survey.

MeSH terms

Acute Disease
Aortic Aneurysm, Thoracic / classification
Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / classification
Aortic Dissection / surgery*
Canada
Health Knowledge, Attitudes, Practice*
Humans
Practice Patterns, Physicians'*
Surveys and Questionnaires
Thoracic Surgery*
Thoracic Surgical Procedures / methods*