Thoracic Aortic Aneurysm Service
- The Team
- History of the Thoracic Aortic Aneurysm Service
- Liverpool Cardiovascular Surgery LCS
- Healthy and Diseased Aorta
- Medicine
- Surgery
- Aortic Valve Repair and Ross Programme - Natural Valve Substitutes
- Outcomes
- Research and Innovation
- Your Involvement
- The Wider Team Caring for You
- Meetings Collaborations and Networks
- Frequently Asked Questions
- Patient Stories
- Aortic Booklet
- Your Healthy Aorta Campaign
- Information for Referring Doctors
- References
- Team Photograph Album
- Patient Support
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.
Read more about recommendations for diagnosis, early management, referral and transfer within the North West of England, North Wales and Isle of Man.
Acute Aortic Syndrome Pathway v3
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.
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.
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
http://www.annalsthoracicsurgery.org/article/S0003-4975(02)04147-4/pdf
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.
These talks have been presented internally and all the data contained may not have been published in peer reviewed journal. In addition the talks may not be comprehensively cited. These data and talks are not for general redistribution without permission.
If you wish to access this data please e-mail: mark.field@lhch.nhs.uk
- 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
- Endocarditis
Figure: Mortality outcomes (Excluding slavage procedures) pre and post specialised aortic rota.
Key Quality Markers for investigation, referral and treatment times
Annual State of the Service Reports
- State of the Service 2017/18 (If you wish to access this report, please e-mail: mark.field@lhch.nhs.uk)
Aortic Arch Surgery Outcomes
DownloadAortic Dissection Outcomes
DownloadHemiarch vs Arch Meta Analysis
DownloadGenetics of Aortic Disease
DownloadOutcomes for management of infected aortic root grafts
DownloadOutcomes for management of thoracoabdominal aortic disease
DownloadOutcomes for management of aortic patients during COVID-19.
DownloadMonitoring Spinal Cord Function in Aortic Surgery
DownloadTransfers 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.