The surgeon effect: Volume-outcome relationship in acute type A aortic dissection.

Authors

Manuel Giraldo-Grueso, Aryan Meknat, Xander Jacquemyn, Derek Serna-Gallegos, Irsa Hasan, Takuya Ogami, Johannes Bonatti, David Kaczorowski, Danny Chu, Ibrahim Sultan

Published in

JTCVS open. Volume 32. Pages 101832. Epub May 04, 2026.

Abstract

Despite advances in technical and perioperative care, surgery for acute type A aortic dissection (ATAAD) carries significant morbidity and mortality. This study evaluated whether high-volume aortic surgeons independently improve perioperative and long-term outcomes compared to their low-volume counterparts.
Patients who underwent surgery for ATAAD between 2011 and 2024 were identified. A high-volume surgeon was considered one who performed surgery for ATAAD on more than 10 patients annually. Patients were stratified into 2 groups based on the surgeon performing their operation, either a high-volume or low-volume aortic surgeon.
A total of 785 patients underwent ATAAD repair, including 715 (91.1%) performed by high-volume surgeons and 70 (8.9%) performed by low-volume surgeons. Preoperative demographics were similar in the 2 groups, although patients operated on by low-volume surgeons had a lower rate of malperfusion (9.9% vs 17.4%; P = .024), had a lower prevalence of peripheral vascular disease (22.5% vs 38.1%; P = .01), and were less likely to have undergone previous cardiac surgery (5.6% vs 14.4%; P = .04). High-volume surgeons performed significantly more aortic root reconstructions (64.1% vs 43.7%; P = .001) and frozen elephant trunk procedures (10.6% vs 4.2%; P = .08). High-volume surgeons were associated with lower 30-day mortality (12.5% vs 22.5%; P = .017), fewer reoperations for bleeding (16.5% vs 26.8%; P = .03), and shorter intensive care unit (ICU) stay (median, 69.3 hours vs 112 hours; P < .001). Kaplan-Meier survival analysis showed that patients operated on by a high-volume surgeon had superior overall survival (P = .04, log-rank test).
High-volume surgeons were associated with superior early outcomes in ATAAD repair, including lower operative mortality, reoperation for bleeding, and ICU utilization, despite performing more complex procedures.

PMID:
42604306
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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