PP74. Acute Aortic Treatment Center - Time to Change the Paradigm

Acute aortic syndromes are life threatening. Time is of the essence as mortality rises with increasing time after the acute episode. The keys to successful treatment of acute aortic disease include early diagnosis, transfer to the appropriate care facility, rapid institution of therapy, availability of cardiovascular anesthesia, and dedicated cardiovascular intensive care unit care. To report the outcomes of a pathway, an Acute Aortic Treatment Center (AATC), to expedite the care of acute aortic syndromes in a major metropolitan area with the hypothesis that “door to intervention” time under 90 minutes reduces mortality and morbidity from acute aortic disease. A database of patients admitted with aortic disease during one year prior to initiation (2007) and one year after initiation of AATC in 2008 was developed. Anatomic and functional outcomes were determined and categorized by Society of Vascular Surgery reporting criteria. Multivariate analysis and Cox proportional hazard analyses were performed. A Total of 621 patients reported with aortic disease to the cardiovascular services; 304 patients were admitted of which 73(25%) were considered to have acute disease. When compared to the year before the AATC there was a 10 % increase in total number of admissions and a 25 % increase in acute pathology after setting up the AATC (p=0.02). There was a 2 fold increase in thoracic aortic dissections admitted to the service. Initiation of AATC resulted in significant reduction in time to definitive therapy (61% decrease) (p=0.016). Despite the increase in acuity, mortality and morbidity rates were unchanged and there were trends to lower ICU and total hospital stay (Table).TableVariablePre- AATCAATCp-valueTotal Inpatients - n (%)130161Acute Presentations - n (%)24(18)49(30)0.02Time to Definite Acute Care - mean ± SD (median) min328±363 (107)129±156 (73)0.015Mortality - n (%)1(4)5(10)0.66Morbidity - n (%)19(79)33(67)0.41LOS ICU - mean ± SD days11±149±80.52LOS Hospital - mean ± SD days21±2015±90.17 Open table in a new tab Institution of AATC increased awareness for correct and early diagnosis of the acute aorta, reduced time to definitive treatment, increased referrals and appeared to impact inpatient hospital stays. Widespread adoption of the AATC paradigm is recommended.