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Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome
1Istituto di Chirurgia Cardiovascolare Università agli Studi di Siena, Unita' Operativa di Chirurgia dell' Aorta Toracica, Istituto di Istituto di Chirurgia del Cuore e Grossi Vasi, Università "La Sapienza," Rome, Italy. euxneri@tin.it
The Journal of Thoracic and Cardiovascular Surgery
|March 10, 2001
Summary
Acute aortic dissection involving coronary arteries can cause myocardial infarction. Direct coronary repair offers a safe alternative to bypass grafting, emphasizing early surgical intervention for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Interventional Cardiology
Background:
- Acute aortic dissection (AAD) can involve coronary ostia, leading to myocardial ischemia and infarction.
- This retrograde dissection poses a significant risk to jeopardized myocardium.
- Surgical management focuses on restoring coronary blood flow and preserving heart muscle.
Purpose of the Study:
- To report outcomes of patients with type A AAD and coronary artery dissection.
- To review surgical experience and illustrate an evolved approach over 15 years.
- To evaluate the safety and efficacy of direct coronary repair versus bypass grafting.
Main Methods:
- Retrospective review of 24 patients with type A AAD and coronary ostial dissection (July 1985-March 2000).
- Analysis of patient demographics, coronary artery involvement, and presenting electrocardiographic findings (Q waves).
- Emergency surgical procedures performed within 10 hours of chest pain onset.
Main Results:
- Hospital mortality was 20% (5 patients), with intraoperative deaths (n=3) and postoperative low cardiac output (n=2).
- The right coronary artery was most frequently involved (11 patients), followed by both coronary arteries (9 patients).
- 16 patients presented with Q waves, indicating significant myocardial injury at admission.
Conclusions:
- Direct coronary repair is a viable and safe alternative to coronary artery bypass grafting in selected patients.
- Aggressive myocardial resuscitation and prompt surgical intervention are critical for successful management.
- Early operation in patients with AAD and coronary involvement improves survival rates.