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Published on: July 7, 2013
Thoracic Endovascular Aortic Repair After Salvage Coronary Artery Bypass Graft for Type A Dissection
Yasutaka Yokoyama1,2, Shizuyuki Dohi2, Takeshi Kinoshita2
1Department of Cardiovascular Surgery, Toda Chuo General Hospital, Saitama, Japan.
Insights
Acute aortic dissection with coronary artery blockage is dangerous. A two-stage treatment, first addressing the blockage then the dissection, can be a successful approach for patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Acute aortic dissection (AAD) is a critical condition with high mortality, particularly when associated with malperfusion.
- Coronary artery malperfusion in AAD poses significant surgical challenges and increases mortality risk.
Observation:
- An 84-year-old male presented with AAD and complete occlusion of the right coronary artery.
- Initial management involved coronary artery bypass grafting to a single branch, with delayed treatment of the AAD.
Findings:
- The patient underwent a two-phase treatment strategy.
- Phase 1: Coronary artery bypass grafting for malperfusion.
- Phase 2: Zone 0 thoracic endovascular aortic repair for AAD, performed two months later, resulting in an uneventful recovery.
Implications:
- This staged approach may offer a viable treatment option for AAD complicated by complete coronary artery occlusion.
- Prioritizing malperfusion treatment followed by endovascular repair of the aorta could improve outcomes in complex AAD cases.
- Further research is warranted to validate this two-stage therapeutic strategy in a broader patient cohort.
Abstract:
Acute aortic dissection (AAD) is a life-threatening condition. It has a high death rate, especially in malperfusion. An 84-year-old man diagnosed with AAD with complete right coronary artery occlusion underwent bypass of only 1 branch of the coronary artery; the chest was closed without treating the AAD. After 2 months, zone 0 thoracic endovascular aortic repair was performed for the AAD. The patient was uneventfully discharged. Treating AAD with complete right coronary artery occlusion for malperfusion first, followed by 2 phases of thoracic endovascular aortic repair for AAD, may be a useful treatment option.
