Aortic dissection has remained one of the greatest challenges in surgery. Significant technological advancements in cardiopulmonary bypass, myocardial protection, and endovascular aortic repair have moved the needle some, but outcomes remain disappointing.
We as aortic surgeons in multidisciplinary aortic centers around the United States and the world have isolated ourselves from each other at "completing" institutions, and sometimes within the same institution! All of us lose when we don't work together to find out answers.
How can we improve outcomes from aortic dissection?
I commend the IMPROVE-AD trial principal investigators for their stalwart dedication to find more answers for type B dissections. But what about answers for type A dissections?
We think the outcome for type A dissections are 60% survival at 10 years, but we really don’t know. Misdiagnosis, late diagnosis, and no mandatory reporting leaves us in the dark about the real outcomes.
I think we should consider a Type A dissection national registry. Even with all the shortcomings we need this, but we need buy in.
What's in it for me? What makes this worth my time? How do I explain using my nurse practitioners, nurses, physician associates, administrative support team for this effort?
Maybe, just maybe, it’s time we stopped the blockade on progress in these complicated areas of aortic surgery and worked together to get some answers.
The questions I get asked by medical students and residents about outcomes from Type A dissections now, are the same questions I asked 25 years ago in Medical School, and we still do not have sufficient answers.....although we have some....THINK AORTA, because the faster you identify the aortic dissection, the better the outcome. Resolve malperfusion before taking the patients for a Type A repair or you will have a terrible outcome and malperfusion to the brain results in a terrible outcome.
Let's figure out how to share all the national data for type A dissections and work together.....crazy idea I know, but I think we can.
Many of us have come up together as colleagues and friends and are now in positions of significance in programs around the country. Many of us want to know the answers, and many of us are sad that we know so little about this disease and how to make things better for these patients and families.
I am proud to be part of the THINK AORTA international campaign. Raising awareness about aortic disease, early identification of aortic dissection, and the THINK AORTA THINK FAMILY campaign has helped save lives. Teaching healthcare practitioners and the families with aortic disease that the family is now at risk and needs to be checked out is progress, but there is larger project.
We need to establish a US Aortic Dissection Registry now. I want to make sure we don't have this same conversation in 25 years from now.
Benjamin Youdelman
Director of Thoracic Aortic Surgery, Co-Director Maimonides Aortic Center, Brooklyn
New York
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