Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity - Retrospective Cohort Study

Sep 30, 2026

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Acute Type A aortic dissection repair is a high-risk operation with substantial in-hospital mortality. This retrospective cohort study assesses whether introducing an On-Call Specialist Aortic Rota at a single centre improves outcomes and alters repair complexity for patients treated between January 2015 and October 2023. After the rota introduction in September 2020, surgeons met minimum annual case and ATAAD volume requirements. Post-implementation analysis compares pre-Rota and post-Rota groups using unadjusted and multivariable models.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

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Interdisciplinary CardioVascular and Thoracic Surgery 2025, 40(12), ivaf262 ORIGINAL ARTICLE [https://doi.org/10.1093/icvts/ivaf262](https://doi.org/10.1093/icvts/ivaf262) Advance Access publication 28 October 2025 Cite this article as: Pruna-Guillen R, Rojanathagoon T, Oo A, Adams B, Lall K, Yap J et al. Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study. Interdiscip CardioVasc Thorac Surg 2025; doi:10.1093/icvts/ivaf262. Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study Robert Pruna-Guillen 1; Thanakorn Rojanathagoon1; Aung Oo1,2; Benjamin Adams1; Kulvinder Lall1; John Yap1; Carmelo Di Salvo1; Rakesh Uppal1; Ana Lopez-Marco 􀀃 ,1,2 1 Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London EC1A 7BE, United Kingdom 2William Harvey Research Institute, Queen Mary University, Charterhouse Square, London EC1M 6BQ, United Kingdom 􀀃 Corresponding author. Ana Lopez-Marco, Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom ([ana.lopez-marco@nhs.net](ana.lopez-marco@nhs.net)). Received: July 22, 2025; Revised: October 4, 2025; Accepted: October 18, 2025 Graphical abstract Abstract Objectives: Acute Type A aortic dissection (ATAAD) repair is a high-risk procedure with significant in-hospital mortality. This study evaluates the impact of implementing an On-call Specialist Aortic Rota on ATAAD repair outcomes. Author Contributions: Drs Pruna-Guillen and Rojanathagoon contributed equally to this work. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ([https://creativecommons.org/licenses/](https://creativecommons.org/licenses/)[ ](https://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial reuse, please contact [reprints@oup.com](reprints@oup.com) for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please [contact journals.permissions@oup.com](contact journals.permissions@oup.com). VASCULAR DISEASE 2 Interdisciplinary CardioVascular and Thoracic Surgery, 2025, Volume 40, Issue 12 Methods: Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n ¼ 406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups. Results: Preoperative characteristics were similar between groups (mean age 59.7 ± 14 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P ¼ .049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P ¼ .033). Group B had a higher rate of aortic root replacement (44% vs 35%, P ¼ .008), lower ascending aorta and hemiarch replacement (40% vs 53%, P ¼ .013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P ¼ . 139) and frozen elephant trunk (20% vs 14%, P ¼ . 171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P ¼ .250) and continuous renal replacement therapy (9.8% vs 12.3%, P ¼ . 196), were comparable between groups, while tracheostomy rates were significantly lower in Gr

FAQs

What question does the study address about ATAAD repair?

It evaluates the impact of implementing an On-Call Specialist Aortic Rota on ATAAD repair outcomes and repair complexity.

How was the on-call specialist rota introduced and what volume requirements applied?

Introduced in September 2020, it required surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually.

What were the main findings regarding mortality and surgical complexity?

Rota implementation was associated with lower in-hospital mortality in multivariable analysis, and postoperative practice patterns shifted toward more extensive repairs, including higher aortic root replacement rates.

Sep 30, 2026

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