Management of acute type A aortic dissection in the Nordic countries.

BackgroundSeveral aspects of acute type A aortic dissection (ATAAD) management remain debated. The strategies for arterial cannulation, cerebral protection, temperature management, and extent of aortic resection are all contested. We aimed to explore and describe variations in the current management of patients with ATAAD in the Nordic countries, which form a limited geographic region with similar healthcare systems.MethodsA 32-item questionnaire regarding organizational and periprocedural aspects of care for patients with ATAAD was sent to 17 Nordic cardiac surgery units, prospective collaborators in the Nordic Consortium for Acute type A Aortic Dissection. Results were summarized using descriptive statistics.ResultsThe response rate was 12/17 (71%). Fifty-eight percent of centers used femoral artery cannulation, of whom two centers (17%) used femoral artery cannulation in addition to another method. Nine centers (75%) used cerebral perfusion in most of surgical repairs requiring HCA, and among those using cerebral perfusion, 92% opted for antegrade cerebral perfusion. Five centers (42%) stated that total arch replacements were never performed. Valve sparing root replacements were performed by seven centers (58%). Regarding postoperative surveillance, all centers reported that CT-scans were performed at 6-12 months intervals.ConclusionAlthough strategies for pre-, peri-, and postoperative management of patients with ATAAD could be expected to be reasonably similar, we found several differences in almost all aspects of management. The current survey may help identify relevant research questions that can be explored in the NORCAAD2 database, ultimately contributing to the development of consensus documents and guidelines.