{"title":"Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.","authors":"Lokeswara Rao Sajja, Gopichand Mannam, Prashanthi Beri, Balakrishna Nagalla","doi":"10.1007/s12055-025-02038-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The management of acute type A aortic dissection (ATAAD) remains a challenge in cardiac surgery, with significant variability in practices influenced by surgeon experience, institutional resources, and patient demographics. This survey aims to evaluate the current trends in ATAAD management among Indian cardiac surgeons.</p><p><strong>Methods: </strong>A nationwide survey was conducted among Indian cardiac surgeons, collecting data on preoperative, intraoperative, and postoperative practices, as well as surgeon demographics and institutional case volumes. The survey questionnaire was distributed to 380 active Indian cardiac surgeons. Key trends and factors influencing decision-making were analyzed.</p><p><strong>Results: </strong>Two hundred surgeons responded to the survey questionnaire. In patients over 80 years of age, the management was conservative, with 73.49% of surgeons avoiding surgery. Timing of surgery within 24 h was prioritized by 68.37%. Axillary artery cannulation (55.81%) and antegrade cerebral perfusion (77.67%) were the most favored techniques. Deep hypothermia (18-20 °C) was used by 26.51% of surgeons, and moderate hypothermia (25-28 °C) was increasingly used by 32.09% of surgeons during circulatory arrest. Postoperative surveillance relied mainly on computed tomography angiography (CTA) (88.37%), while magnetic resonance angiography (MRA) was underutilized (19.53%). High-volume surgeons and centers were more likely to adopt advanced techniques. Barriers included limited access to resources, specialized training, and regional disparities in healthcare infrastructure.</p><p><strong>Conclusion: </strong>This study highlights significant variability in ATAAD management practices in India, underscoring the need for standardized guidelines tailored to the local context. Investments in training, infrastructure, and regional referral systems are essential to harmonize care and improve outcomes. India has the potential to optimize ATAAD management and enhance patient survival.</p><p><strong>Graphical abstract: </strong>Sajja, L.R., Mannam, G., Beri, P., Nagalla B. Indian Journal of Thoracic and Cardiovascular Surgery. Central picture: Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02038-y.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1408-1416"},"PeriodicalIF":0.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450175/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-02038-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/4 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The management of acute type A aortic dissection (ATAAD) remains a challenge in cardiac surgery, with significant variability in practices influenced by surgeon experience, institutional resources, and patient demographics. This survey aims to evaluate the current trends in ATAAD management among Indian cardiac surgeons.
Methods: A nationwide survey was conducted among Indian cardiac surgeons, collecting data on preoperative, intraoperative, and postoperative practices, as well as surgeon demographics and institutional case volumes. The survey questionnaire was distributed to 380 active Indian cardiac surgeons. Key trends and factors influencing decision-making were analyzed.
Results: Two hundred surgeons responded to the survey questionnaire. In patients over 80 years of age, the management was conservative, with 73.49% of surgeons avoiding surgery. Timing of surgery within 24 h was prioritized by 68.37%. Axillary artery cannulation (55.81%) and antegrade cerebral perfusion (77.67%) were the most favored techniques. Deep hypothermia (18-20 °C) was used by 26.51% of surgeons, and moderate hypothermia (25-28 °C) was increasingly used by 32.09% of surgeons during circulatory arrest. Postoperative surveillance relied mainly on computed tomography angiography (CTA) (88.37%), while magnetic resonance angiography (MRA) was underutilized (19.53%). High-volume surgeons and centers were more likely to adopt advanced techniques. Barriers included limited access to resources, specialized training, and regional disparities in healthcare infrastructure.
Conclusion: This study highlights significant variability in ATAAD management practices in India, underscoring the need for standardized guidelines tailored to the local context. Investments in training, infrastructure, and regional referral systems are essential to harmonize care and improve outcomes. India has the potential to optimize ATAAD management and enhance patient survival.
Graphical abstract: Sajja, L.R., Mannam, G., Beri, P., Nagalla B. Indian Journal of Thoracic and Cardiovascular Surgery. Central picture: Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02038-y.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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