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Acute aortic dissection type A with acute coronary involvement: a novel classification

Ying-Fu Chen1, Tsu-Ming Chien, Cai-Pei Yu

  • 1Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung Taiwan.

International Journal of Cardiology
|July 30, 2013
PubMed

Insights

Acute coronary involvement in aortic dissection type A is a serious condition. Patients with this complication are younger and have higher rates of aortic regurgitation, aiding surgical decisions.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Acute aortic dissection (AAD) type A can involve the coronary arteries, posing a significant risk.
  • Acute coronary involvement (ACI) in AAD type A is a potentially fatal complication.
  • Understanding the characteristics of ACI in AAD type A is crucial for patient management.

Purpose of the Study:

  • To determine the specific characteristics of patients experiencing acute coronary involvement (ACI) secondary to acute aortic dissection (AAD) type A.
  • To identify demographic, clinical, and pathological features associated with ACI in AAD type A.

Main Methods:

  • Retrospective analysis of 142 patients surgically treated for AAD type A between 1997 and 2011.
  • Inclusion of 20 patients (14.1%) who presented with ACI.
  • Comparison of patient demographics, clinical presentation, and outcomes between groups with and without ACI.

Main Results:

  • Patients with ACI were significantly younger (51.8 vs. 61.0 years) and had a higher rate of aortic regurgitation (95.0% vs. 53.5%).
  • Intramural hematoma was less common in patients with ACI (5.0% vs. 32.8%).
  • In-hospital mortality rates were similar between patients with and without ACI (20.0% vs. 19.7%).

Conclusions:

  • Acute coronary involvement in AAD type A is not invariably linked to coronary malperfusion.
  • Key differentiating factors for ACI include younger age, higher aortic regurgitation, and lower prevalence of intramural hematoma.
  • A novel 4-category classification scheme based on surgical pathology is proposed to aid treatment decisions for this patient cohort.
Abstract

Keywords:
Acute aortic dissectionAortic and vascular diseaseCV surgeryCoronary involvementCoronary malperfusion

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