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Coronary artery involvement in type A aortic dissection: Fate of the coronaries

Fatima Kayali1, Matti Jubouri2, Mohammed Al-Tawil3

  • 1School of Medicine, University of Central Lancashire, Preston, UK.

Journal of Cardiac Surgery
|September 30, 2022
PubMed

Insights

Coronary artery involvement in Type A aortic dissection (TAAD) is a critical complication. Early diagnosis and intervention are vital for improving patient outcomes in TAAD.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Aortic Dissection

Background:

  • Type A aortic dissection (TAAD) is a life-threatening condition involving the thoracic aorta, with potential extension into coronary arteries.
  • Coronary artery compromise in TAAD can result from dissection flap extension or external compression, leading to myocardial ischemia.
  • Delayed diagnosis of coronary involvement in TAAD can impede timely and life-saving interventions.

Purpose of the Study:

  • To review the current literature on the incidence, mechanisms, diagnostic strategies, and treatment options for coronary artery involvement in Type A aortic dissection.
  • To highlight the clinical significance and impact of coronary artery involvement on patient prognosis.

Main Methods:

  • A comprehensive literature search was conducted across major electronic databases (PubMed, Ovid, Scopus, Embase).
  • Relevant studies reporting on coronary artery involvement in TAAD were identified and data extracted.

Main Results:

  • Incidence of coronary artery involvement in TAAD is infrequently reported, with diagnoses made preoperatively, intraoperatively, or post-mortem.
  • Treatment approaches for coronary involvement in TAAD varied, with a majority undergoing revascularization via bypass grafting or local repair.
  • Coronary artery involvement significantly increases the mortality and morbidity associated with TAAD, with the right main coronary artery being more frequently affected.

Conclusions:

  • Accurate diagnosis and prompt, effective interventions are crucial for improving outcomes in TAAD with coronary involvement.
  • Further large-scale cohort studies and extended clinical trials are necessary to establish definitive treatment guidelines.
Abstract

Keywords:
CABGCADaortic dissectionaortic surgerycoronary arterytype A aortic dissection (TAAD)

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