Objective: An inverse relationship between volume and mortality in some cardiothoracic surgical\nprocedures has been previously established, leading to suggestions that acute aortic dissection\nshould not be operated in community or low volume heart centers. We therefore reviewed our\nexperience to compare with published data. Methods: Retrospective review of 27 patients who\nunderwent proximal aortic surgery by a single surgeon at an inner city community hospital between\nMay 2004 and April 2015. 16 patients, mean age 51.7 �± 13.6 years old, 75.0% males underwent\nemergency surgery for acute Stanford type A aortic dissection, while 9 with root or ascending\naortic aneurysm, mean age 50.3 �± 15.0 years old, 88.9% males had elective proximal aortic\nsurgery. 2 patients with arch aneurysm were excluded. Results: Four (25.0%) patients with acute\ndissection were in Penn class A, 3 (18.7%) Penn B, 3 (18.7%) Penn C and 6 (37.5%) Penn B+C. 10\n(62.5%) patients underwent emergency root replacement with 60.0% (6/10) mortality all related\nto malperfusion including 2 patients with bloody stools, while 6 (37.5%) underwent supracoronary\ngraft replacement with 16.6% (1/6) mortality from cardiac tamponade. The 5-year survival\nwas 89.0%. In patients with aortic aneurysm, 8 (88.9%) underwent elective root replacement and\n1 (11.1%) supracoronary graft replacement with zero mortality. Conclusion: Supracoronary graft\nreplacement is performed for the majority of uncomplicated acute type A dissections and can be\nundertaken by the average general cardiac surgeon with acceptable results. Visceral malperfusion\nespecially when associated with bloody stools portends a poor prognosis, and aortic dissection\nshould be excluded in any Marfan patient presenting with acute abdomen. Delaying intervention\nin attempting transfer to a tertiary hospital can potentially increase preoperative mortality,\nknown to rise with each passing hour from onset of acute dissection. Patients presenting therefore\nto community hospitals should probably undergo surgery there to avoid complications associated\nwith delay.
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