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[Myocardial Ischemia in Acute Type A Aortic Dissection; Coronary Artery Dissection and Functional Ischemia]

Masanao Nakai1, Fumio Yamasaki, Hiroshi Mitsuoka

  • 1Department of Cardiovascular Surgery, shizuoka Municipal Hospital, Shizuoka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 24, 2016
PubMed

Insights

Acute type A aortic dissection can cause myocardial ischemia, a fatal complication. Surgical intervention, including coronary-artery bypass grafting (CABG), shows a 20.1% hospital mortality rate in these high-risk patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Acute type A aortic dissection is a life-threatening condition.
  • Myocardial ischemia is a severe complication associated with this dissection.
  • Evaluating surgical outcomes for patients with both conditions is critical.

Observation:

  • A study reviewed 364 patients with acute type A aortic dissection from 1986-2014.
  • Twenty-four patients required myocardial revascularization.
  • Surgical approaches included coronary-artery bypass grafting (CABG), re-CABG, and Carrel patch procedures.

Findings:

  • Hospital mortality was 20.1% for patients undergoing CABG.
  • Detachment of the coronary artery from the aorta occurred in some CABG patients without ischemic symptoms.
  • Patients with ischemic changes but uninvolved coronary arteries did not undergo CABG, with ischemia potentially caused by other factors.

Implications:

  • Surgical management of acute type A aortic dissection with myocardial ischemia carries significant risk.
  • Coronary artery involvement and detachment are key considerations for surgical planning.
  • Further research is needed to optimize outcomes for these complex cases.

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