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Long-Term Outcomes of Surgical Treatment for Acute Type-A Aortic Dissection with Coronary Artery Involvement

Shuyang Lu1, Yun Zhao2, Kai Song1

  • 1Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases.

International Heart Journal
|September 30, 2021
PubMed

Insights

Surgical repair of acute type-A aortic dissection (aTAAD) with coronary artery involvement shows comparable long-term survival. Coronary artery bypass grafting offers a safe and effective approach for these complex patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Dissection

Background:

  • Surgical management of acute type-A aortic dissection (aTAAD) with coronary artery involvement presents challenges.
  • Prognosis and optimal surgical strategies for aTAAD involving coronary arteries remain debated.

Purpose of the Study:

  • To investigate the characteristics, surgical strategies, and prognosis of patients with aTAAD and coronary artery involvement.
  • To compare outcomes between different surgical approaches for coronary artery involvement in aTAAD.

Main Methods:

  • Retrospective analysis of 65 patients with aTAAD and coronary artery involvement (Sept 2005 - Jan 2012).
  • Patients divided into two groups: aTAAD repair with coronary ostia reimplantation (Neri type-A) and aTAAD repair with coronary artery bypass grafting (CABG) (Neri type B and C).

Main Results:

  • In-hospital mortality was 8.1% for Neri type-A vs. 21.4% for Neri type B/C (P=0.124).
  • Intensive care unit (ICU) stay was significantly longer for Neri type B/C (12.4 days) vs. Neri type-A (5.8 days) (P=0.009).
  • Postoperative renal and respiratory dysfunction showed higher rates in Neri type B/C (P=0.062, P=0.036). Long-term survival was comparable between groups (P=0.386).

Conclusions:

  • Coronary artery dissection in aTAAD (Neri type B/C) is associated with higher early mortality but similar long-term survival post-discharge.
  • Combined immediate CABG and aortic repair is a safe, effective, and acceptable strategy for aTAAD with coronary involvement.

Keywords:
Coronary malperfusionCoronary artery bypass graftingNeri type

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