Original SubmissionAortic Root Surgery: Does High Surgical Volume and a Consistent Perioperative Approach Improve Outcome?

There is evidence that high surgical volume and team consistency improve outcomes. Mortality of 4%-12% for aortic root surgery has been reported in the United States and UK. We aim to assess outcomes of patients undergoing aortic root surgery by a consistent, high-volume team. Data on patients undergoing elective or urgent aortic root replacement (ARR) were collected prospectively. Patients undergoing emergency surgery were excluded. A standardized perioperative approach was maintained and was achieved by delivering training to team members, including surgical trainees, anesthetic, nursing, and perfusion staff, whenever there was a change of team. Between 2005 and 2014, 344 patients underwent ARR. Median age was 59 years (18-86) and 74% were men. Procedures included ARR (biological [186; 54%] or mechanical [101; 29.4%]) and valve sparing root replacement, remodeling technique (57; 16.6%). A total of 42 patients (12.2%) underwent concomitant procedures. There were 4 (1.2%) in-hospital deaths and no incidence of stroke. In total, 3 (0.9%) required resternotomy for bleeding and 8 (2.3%) required hemofiltration. Follow-up was complete for 94% of patients with median intensive care unit and hospital stays of 1 and 6 days, respectively. Follow-up was complete for 94% of patients at a median of 5.6 years with 98% freedom from reoperation and prosthetic valve dysfunction. There was 90% freedom from aortic insufficiency at 7 years in the valve sparing root replacement, remodeling technique cohort. We have demonstrated that high surgical volume and standardized care improves outcomes in aortic root surgery. Maintaining a consistent perioperative approach ensures team members are aware and well rehearsed in their roles, thereby improving outcomes.