Aortic centres should represent the standard of care for acute aortic syndrome

作者：Mariscalco Giovanni; Maselli Daniele; Zanobini Marco; Ahmed Aamer; Bruno Vito D; Benedetto Umberto; Gherli Riccardo; Gherli Tiziano; Nicolini Francesco

来源：European Journal of Preventive Cardiology, 2018, 25(1_suppl): 3-14.

DOI：10.1177/2047487318764963

<jats:sec><jats:title>Background</jats:title><jats:p> Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The design was a quantitative and qualitative review of observational studies. We searched PubMed/ MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS. </jats:p></jats:sec>

• 出版日期2018-6