Related Experiment Video

Updated: Jul 15, 2026

Novel and Innovative Hybrid Technique for Type A Aortic Dissection
06:26

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Published on: March 28, 2025

[Coronary malperfusion due to acute type A aortic dissection; surgical strategy and results]

Toshihisa Asakura1, S Gojo, M Ishikawa

  • 1Department of Cardiovascular Surgery, Saitama Medical University, Saitama, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 10, 2007
PubMed

Insights

Coronary malperfusion in acute type A aortic dissection (DAA) is deadly, especially affecting the left coronary artery. Early surgery and strong mechanical support, like left ventricular assist systems (LVAS), improve survival in these critical patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Context:

  • Acute type A aortic dissection (DAA) can cause lethal coronary malperfusion.
  • Left coronary malperfusion leading to acute global myocardial infarction (AMI) presents significant surgical challenges.
  • Review of a single institution's experience from 1990-2005 with 260 DAA patients.

Purpose:

  • To review experience and illustrate an approach to critically ill patients with DAA and coronary malperfusion.
  • To classify malperfusion mechanisms into 4 types based on perioperative findings.
  • To discuss individualized surgical management strategies for DAA-associated coronary malperfusion.

Summary:

  • Twenty patients (7.7%) with DAA experienced coronary malperfusion (11 left, 9 right).
  • Hospital mortality was 22% for right coronary malperfusion and 45% for left.
  • Veno-arterial bypass (VAB) was associated with universal mortality; stronger assist devices like LVAS improved survival.

Impact:

  • Aggressive myocardial resuscitation and early operation are crucial for managing DAA with coronary malperfusion.
  • Veno-arterial bypass is ineffective for DAA-induced severe heart failure.
  • Strong mechanical support, including LVAS, is recommended before multi-organ failure exacerbation; supplemental CABG and LV support yield reasonable results.

More Related Videos

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)13:10

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Published on: April 24, 2017

Related Concept Videos

Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...