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Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection

Maximilian Kreibich1, Joseph E Bavaria2, Emanuela Branchetti2

  • 1Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

The Annals of Thoracic Surgery
|November 17, 2018
PubMed

Insights

Coronary artery malperfusion in type A aortic dissection requires tailored surgical repair. Coronary artery bypass grafting is recommended for severe lesions, while ostial repair is effective for less complex cases.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Dissection

Background:

  • Coronary artery malperfusion is a serious complication of type A aortic dissection.
  • Understanding the different types of coronary artery involvement is crucial for surgical planning.

Purpose of the Study:

  • To review the surgical experience with coronary artery malperfusion secondary to type A aortic dissection.
  • To evaluate the outcomes of different repair strategies for coronary artery malperfusion.

Main Methods:

  • Retrospective review of 76 patients with coronary artery malperfusion between 2002 and 2017.
  • Classification of lesions into type A (ostial flap), type B (coronary artery involvement), and type C (complete avulsion).
  • Analysis of surgical repair success rates, need for coronary artery bypass grafting, and patient survival.

Main Results:

  • Ostial repair was successful in 88% of type A and 63% of type B lesions.
  • Coronary artery bypass grafting was necessary for all type C lesions and some type B lesions.
  • Perioperative mortality was 24%, but survival rates were similar between patients with and without coronary artery malperfusion.

Conclusions:

  • Coronary artery bypass grafting is recommended for type C lesions or those with underlying coronary artery disease.
  • Ostial pledgetted suture repair is effective for type A and type B lesions when antegrade cardioplegia is feasible.
  • Despite high perioperative mortality, long-term survival is not adversely affected by coronary artery malperfusion with appropriate management.
Abstract

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