{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T11:26:30Z","timestamp":1770549990172,"version":"3.49.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Acute Type A aortic dissection (ATAAD) repair is a high-risk procedure with significant in-hospital mortality. This study evaluates the impact of implementing an On-call Specialist Aortic Rota on ATAAD repair outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n\u2009=\u2009406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Preoperative characteristics were similar between groups (mean age 59.7\u2009\u00b1\u200914 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P\u2009=\u2009.049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P\u2009=\u2009.033). Group B had a higher rate of aortic root replacement (44% vs 35%, P\u2009=\u2009.008), lower ascending aorta and hemiarch replacement (40% vs 53%, P\u2009=\u2009.013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P\u2009=\u2009.139) and frozen elephant trunk (20% vs 14%, P\u2009=\u2009.171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P\u2009=\u2009.250) and continuous renal replacement therapy (9.8% vs 12.3%, P\u2009=\u2009.196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs 9.7%, P\u2009=\u2009.036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The period after introducing an On-Call Specialist Aortic Rota was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00) and accompanied by a practice-pattern shift towards more extensive repairs. Given the observational design and potential for residual confounding and calendar-time bias, these findings should be viewed as associative rather than causal and require confirmation in multicentre studies with longer follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registry Number<\/jats:title>\n                    <jats:p>CEU\/2019\/11118.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf262","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:47:58Z","timestamp":1761655678000},"source":"Crossref","is-referenced-by-count":2,"title":["Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1872-6275","authenticated-orcid":false,"given":"Robert","family":"Pruna-Guillen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanakorn","family":"Rojanathagoon","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aung","family":"Oo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]},{"name":"William Harvey Research Institute, Queen Mary University , Charterhouse Square, London EC1M 6BQ,","place":["United 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7BE,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh","family":"Uppal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9330-3948","authenticated-orcid":false,"given":"Ana","family":"Lopez-Marco","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London EC1A 7BE,","place":["United Kingdom"]},{"name":"William Harvey Research Institute, Queen Mary University , Charterhouse Square, London EC1M 6BQ,","place":["United 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