1 Recommendations

Guidance

1.1 Evidence on the safety and efficacy of aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection should:

Inform the clinical governance leads in their healthcare organisation.
If possible, give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
If possible, ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Enter details about all patients having aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection into the NICOR Adult Cardiac Surgery Audit. Contact nicor.auditenquiries@nhs.net for details.
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 This procedure should only be done in specialised centres by surgeons experienced in aortic surgery and with special training in this procedure.

1.5 Further research could include randomised controlled trials or analysis of registry data. It should include details of patient selection and report 30‑day mortality, quality of life, and long-term outcomes including aortic remodelling and complications.