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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Preoperative coronary angiography and outcomes in acute type A aortic dissection with coronary malperfusion: A
Kentaro Fukano1, Yusuke Sasabuchi2, Hiroki Matsui3
1Department of Anesthesiology and Critical care medicine, Jichi Medical University Saitama Medical Center, Saitama-shi, Saitama-ken, Japan.
Insights
For acute type A aortic dissection with coronary malperfusion, initial coronary angiography before aortic repair showed no significant difference in in-hospital mortality compared to direct aortic repair. This finding impacts surgical strategy for this critical condition.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Research
Background:
- Optimal management for acute type A aortic dissection (ATAAD) with coronary malperfusion is not well-defined.
- Uncertainty exists regarding the best approach: coronary angiography followed by aortic repair versus direct aortic repair.
Purpose of the Study:
- To compare in-hospital mortality between two surgical strategies for ATAAD with coronary malperfusion.
- Evaluate outcomes of coronary angiography followed by aortic repair versus direct aortic repair.
Main Methods:
- Retrospective cohort study using the Japanese Diagnosis Procedure Combination database (July 2010-March 2022).
- Included 1167 emergent surgery patients with ATAAD and coronary malperfusion.
- Compared in-hospital mortality between coronary angiography (CAG) and direct aortic repair (DAR) groups using multivariable Cox regression.
Main Results:
- No significant difference in in-hospital mortality was observed between the CAG group (n=508) and the DAR group (n=659).
- Hazard ratio for in-hospital mortality was 1.05 (95% CI, 0.83-1.34; p=0.661).
Conclusions:
- In-hospital mortality for ATAAD with coronary malperfusion did not significantly differ between patients undergoing initial coronary angiography and those undergoing direct aortic repair.
- The findings suggest that direct aortic repair may be a viable option without compromising in-hospital survival.
Background:
The optimal strategy for acute type A aortic dissection (ATAAD) with coronary malperfusion remains unclear. This study aimed to compare in-hospital mortality between coronary angiography followed by aortic repair and direct aortic repair without coronary angiography in patients with ATAAD and coronary malperfusion.
Methods:
We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database, from July 2010 to March 2022. We included patients who were admitted emergently and underwent surgery for ATAAD on the day of admission. Patients were defined as having preoperative coronary malperfusion if they had a diagnosis of acute myocardial infarction present on admission or underwent coronary angiography or percutaneous coronary intervention on the day of surgery. The primary outcome was in-hospital mortality. Patients were categorized as coronary angiography followed by aortic repair (CAG group) or direct aortic repair (DAR group). A multivariable Cox regression model was used to compare the time to in-hospital death between groups.
Results:
We identified 1167 patients with ATAAD with coronary malperfusion. Of these, 508 (43.5 %) were in the CAG group and 659 (56.5 %) were in the DAR group. Cox regression analysis revealed no significant differences in the in-hospital mortality between the groups (hazard ratio, 1.05; 95 % confidence interval, 0.83 to 1.34, p = 0.661).
Conclusions:
Among patients with ATAAD with coronary malperfusion, in-hospital mortality did not differ significantly between those who underwent coronary angiography followed by aortic repair and those who underwent direct aortic repair.
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