The presence of a multidisciplinary aortic team (MAT) is a major component of the decision-making algorithm for the management of complex aortic disease. The guidelines from the American Heart Association allow for surgical intervention at ascending aortic diameters up to 0.5 cm below the conventionally accepted threshold in the presence of a MAT [1]. This is largely secondary to the positive relationship between higher volumes and improved outcomes which has been established for multiple types of both proximal and distal aortic surgery [[2], [3], [4]]. However, there is some evidence that the presence of a multidisciplinary team itself is more important than volume alone with respect to optimizing patient outcomes, particularly with respect to aortic dissection [[5], [6], [7]]. Others have advocated that a multidisciplinary team should become standard of care in aortic pathology [[8], [9], [10]], much as it has for heart failure and valvular disease [11].

Despite this, there is no evidence-based guidance as to what constitutes a multidisciplinary team [12,13]. It is generally accepted that such a team should involve a cardiothoracic surgeon, a vascular surgeon, and a cardiologist; however, the involvement of other services including genetics, anesthesiology, perfusion medicine, neurology, neurosurgery, pathology and interventional radiology is variable among institutions [13,14]. There also exists limited data regarding the expected financial and resource impact of implementing such a team within a hospital or health system [10,15], as well as what subpopulations might benefit the most from a MAT, such as genetic aortopathy patients [16,17].

The purpose of this study was to describe a single institution experience of developing and implementing a MAT for arch and thoracoabdominal dissection and aneurysmal pathology, as well as describe the team elements and meeting structure. Additionally, the manuscript investigates the impact of the MAT on surgical practice over time with respect to overall aortic procedural volumes, service line specific volumes, referral patterns, case complexity and multidisciplinary involvement.