Type A aortic dissection repair at high versus low volume centers

Abstract Background There is significant improvement in outcomes when acute type A aortic dissection (ATAAD) repairs are performed at high-volume centers, with both center and surgeon volumes contributing to improved survival. The aim of our study was to evaluate our own network and determine differences in ATAAD outcomes between our high- and low-volume aortic centers. This was an observational, multi-center retrospective study consisting of 205 cases of ATAAD repair within our institution across 3 hospitals within the region that perform cardiac surgery, from January 2017 to January 2025. Data were collected and stratified by center volume (high vs. low), then analyzed. Results There were 164 patients who presented to our high-volume center, while 41 presented to our low-volume centers. When stratified by center volume, there was no significant difference in preoperative characteristics. Cardiopulmonary bypass (CPB) [174 (137–218) versus 236.5 (195.5–288) min, p < 0.001], circulatory arrest [30 (22–45) versus 45 (33–67) min, p = 0.001], and cross clamp times [93 (72–127) versus 131 (94.5–194) min, p = 0.002] were significantly different between high–low volume centers, respectively. The univariable survival analysis did show a significant difference in survival at 3 years—81.5% versus 66.7% [ p = 0.009]. The multivariable Cox regression model showed that having surgery at a high-volume center was associated with a significant difference in 3-year survival [ p = 0.021]. Conclusion Our study showed improved outcomes of type A aortic dissection when surgery was performed by surgeons with greater experience at comprehensive aortic centers.