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A novel classification, management and long-term outcomes of coronary artery involvement in acute aortic dissection

Yi Chang1, Hongwei Guo2, Cuntao Yu2

  • 1Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, China. chantlinguish@163.com.

BMC Cardiovascular Disorders
|June 21, 2023
PubMed

Insights

A new classification for coronary artery involvement in aortic dissection categorizes lesions into simple and complex types. Both types showed comparable survival rates, but unrepaired arteries risk re-involvement.

Area of Science:

  • Cardiovascular Surgery
  • Aortic Dissection
  • Coronary Artery Disease

Background:

  • Aortic dissection frequently involves coronary arteries, complicating surgical management.
  • A simple, effective classification system for coronary artery involvement in aortic dissection is needed.

Purpose of the Study:

  • To introduce a novel classification for coronary artery involvement in aortic dissection.
  • To report the management strategies and outcomes based on this new classification.

Main Methods:

  • Coronary artery lesions were classified as simple (type S) or complex (type C) based on intimal integrity.
  • Complex lesions were managed with coronary artery bypass grafting (CABG), while simple lesions underwent ostial repair or reimplantation.
  • Data from 267 patients (2010-2019) were retrospectively analyzed.

Main Results:

  • Simple lesions (89.9%) were more common than complex lesions (11.1%).
  • Operative mortality was comparable between type S (9.6%) and type C (18.5%) groups (P=0.28).
  • Long-term survival rates at 10 years were 79.8% for type S and 79.2% for type C (P=0.47).

Conclusions:

  • The new classification effectively guides management of coronary artery involvement in aortic dissection, yielding satisfactory outcomes.
  • Untreated coronary arteries with simple lesions are at risk of re-involvement.
  • Vein graft patency remains a concern, especially in non-atherosclerotic arteries.
Abstract

Keywords:
Aortic dissectionCoronary artery

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