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Impact of non-significant right coronary ostial involvement on coronary events in type A aortic dissection surgery

Ling-Chen Huang1, Xiang-Min Hu2, Ai-Kai Zhang2

  • 1Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Interdisciplinary Cardiovascular and Thoracic Surgery
|February 24, 2025
PubMed

Insights

Coronary involvement during type A aortic dissection repair significantly increases the risk of coronary events. Even minor right coronary involvement poses a substantial risk, necessitating careful surgical consideration.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease Research

Background:

  • Coronary-related technical complications are frequent during type A aortic dissection surgical repair.
  • Identifying risk factors for these complications is crucial for improving patient outcomes.
  • The impact of coronary ostial involvement morphology requires further investigation.

Purpose of the Study:

  • To investigate the risk factors for coronary-related technical complications during type A aortic dissection repair.
  • To assess the impact of coronary ostial involvement on the incidence of coronary events.
  • To evaluate the association between the extent of coronary involvement and adverse coronary events.

Main Methods:

  • A cohort of 1168 patients undergoing open surgery for type A aortic dissection from June 2019 to January 2024.
  • Patients were categorized into groups based on the presence and severity of coronary ostial involvement (non-significant, significant, or none).
  • Logistic regression and survival analyses (Kaplan-Meier, Cox regression) were used to identify risk factors and estimate overall survival.

Main Results:

  • Coronary events occurred in 4.97% of patients, with 4.54% requiring bailout coronary revascularization.
  • Patients with any coronary involvement exhibited a significantly higher incidence of coronary events (8.18% vs. 0.79%, P < 0.001).
  • Significant right coronary involvement (OR: 20.58) and non-significant right coronary involvement (OR: 7.05) were independently associated with increased risk of coronary events.

Conclusions:

  • Coronary ostial involvement is a significant risk factor for coronary events following type A aortic dissection repair.
  • Both significant and non-significant right coronary involvement, particularly the latter which is common, warrant close attention due to their association with adverse coronary events.
  • These findings highlight the importance of assessing coronary ostial involvement during surgical planning for type A aortic dissection.
Abstract

Keywords:
bailout coronary revascularizationcoronary eventscoronary ostial involvementtype A aortic dissection

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