Information for Referring Doctors
Patients who browse through these pages and need further support or explanation should contact Sarah.OLeary@lhch.nhs.uk to arrange an appropriate information point.
Acute Aortic Syndrome Pathway
Read more about recommendations for diagnosis, early management, referral and transfer within the North West of England, North Wales and Isle of Man.
How to refer a patient?
Elective referrals may be sent to LHCH addressed to the Aortic Team or directly to one of the consultant surgeons. Urgent referrals, such as patients who need in-patient transfer for surgery within a time period of days to weeks, should be sent to LHCH Coordinators through the urgent system. For emergencies please contact the on-call surgical SpR or consultant surgeon through hospital switchboard.
What to refer?
Patients needing elective, urgent or emergency management of disease in any part of the aorta and its major branches whether that be medical, surgical or endovascular treatments. Patients needing follow-up and surveillance of small to modest size aneurysms may be referred.
What are the risks for my patient?
Patients are offered surgery on the basis of size, expansion, symptoms or acuity.
Size: The key diameter is 5.5cm as the threshold for intervention on the proximal aorta and 6.5cm on the distal aorta. These numbers may be lowered in patients with a familial history of aortic disease or those with connective tissue disorders such a Bicuspid Aortic Valve Syndrome, Marfan Syndrome, Erhlers Danlos Syndrome, Lowis Dietz Syndrome and Turners Syndrome. The threshold may be lower and around 4.0cm when a patient is undergoing cardiac surgery with other indications.
Elefteriades, Annals of Thoracic Surgery 2002
Typically we offer asymptomatic patients surgery when the annual risk of rupture exceeds the mortality risk of surgery.
Expansion: Expansion is considered significant at around 1cm per year.
Symptoms: Symptoms occur for a variety of reasons either related to aortic regurgitation or due to size and compression of surrounding structures.
Risks of intervention at LHCH
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- Root surgery
- Arch surgery
- TAAA surgery
- DHCA and age
- Survival following aortic surgery
- Key Quality Indicators for aortic surgery
- CUSSUM curves for the Aortic Team
Outcomes for repair acute Type A Aortic Dissection
Figure: Mortality outcomes (Excluding slavage procedures) pre and post specialised aortic rota.
Annual State of the Service Reports
- State of the Service 2017/18 (If you wish to access this report, please e-mail: firstname.lastname@example.org)
Key Team Publications in Medical Journals:
- Aortic Arch Surgery Outcomes
- Aortic Dissection Outcomes
- Hemiarch vs Arch Meta Analysis
- Genetics of Aortic Disease
- Monitoring Spinal Cord Function in Aortic Surgery
- Outcomes for management of infected aortic root grafts
- Outcomes for management of thoracoabdominal aortic disease
- Outcomes for management of aortic patients during COVID-19.
Transfers to our hospital Intensive Care Unit from other hospitals may only occur after the on-call Surgeon and Intensivist have agreed to accept the patient. Patients should not be put in an ambulance and transferred until the In-charge Sister confirms that a bed is available for accupancy. The Sister will contact the referring hospital to arrange this process.
As a Tertiary Unit we would look to transfer patients back to their referring hospital in the post operative period. This would occur in general when there are no outstanding surgical issues. This allows us to accept further patients for treatment and is often convenient for patients and their families.