Experience for 107 patients with acute type A aortic dissection involving coronary arteries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jianyang , QIAO Gang , ZOU Gangqiang , SUN Zhigang , HUANG Zhenfeng , LU Wei , CHEN Xiaosan , LI Guangfeng ,  ZHANG Zhidong

Henan Provincial People’s Hospital Heart Centre, Central China Fuwai Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

ZHANG Zhidong, Email: 15838127197@163.com

Keywords：

Acute aortic dissection; coronary artery; coronary artery bypass grafting

DOI：

10.7507/1007-4848.202003031

Video：

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Objective To summarize the clinical feature and treatment experience of patients with acute type A aortic dissection involving coronary arteries.Methods The clinical data of 107 patients with acute type A aortic dissection involving coronary arteries, who received operation between June 5, 2012 and December 31, 2019 in our hospital, were analyzed retrospectively. There were 80 males and 27 females at age of 24-83 (49.8±11.2) years.Results The right coronary artery was involved in 65 patients, the left in 17 patients, and both coronary arteries in 25 patients. There were 48 (44.9%) patients undergoing coronary artery bypass grafting, 49 (45.8%) patients undergoing coronary artery plasty. Fifteen patients died 30 d after the operation, with a mortality rate of 14.0%. Patients with preoperative cardiogenic shock and postoperative acute renal failure had increased risk of death (P<0.05). Eighty-two (88.2%) patients were followed up for 2 to 71 months, and 1 patient had sudden cardiac death during the follow-up period.Conclusion Acute type A aortic dissection with coronary involvement is associated with high misdiagnosis rate and mortality rate. Taking proper strategies for surgical treatment of involved coronary arteries based on precise diagnosis may improve the prognosis of patients.

Citation： LIU Jianyang, QIAO Gang, ZOU Gangqiang, SUN Zhigang, HUANG Zhenfeng, LU Wei, CHEN Xiaosan, LI Guangfeng, ZHANG Zhidong. Experience for 107 patients with acute type A aortic dissection involving coronary arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1015-1019. doi: 10.7507/1007-4848.202003031 Copy

1.	Wang T, Wei D, Evans T, et al. Surgery for type A aortic dissection: 14-year contemporary cohort study. Heart Lung Circ, 2020, [Epub ahead of print].
2.	Uchida K, Karube N, Minami T, <italic>et al</italic>. Treatment of coronary malperfusion in type A acute aortic dissection. Gen Thorac Cardiovasc Surg, 2018, 66(11): 621-625.
3.	郭世超, 孙立忠, 朱俊明, 等. 保留自体头臂血管的孙氏手术在急性主动脉夹层中的应用. 中国胸心血管外科临床杂志, 2018, 25(6): 512-515.
4.	Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
5.	Imoto K, Uchida K, Karube N, <italic>et al</italic>. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg, 2013, 44(3): 419-424.
6.	Girdauskas E, Kuntze T, Borger MA, <italic>et al</italic>. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
7.	Salmasi MY, Al-Saadi N, Hartley P, <italic>et al</italic>. The risk of misdiagnosis in acute thoracic aortic dissection: A review of current guidelines. Heart, 2020, 106(12): 885-891.
8.	Narayan P, Rogers CA, Benedetto U, <italic>et al</italic>. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection. J Thorac Cardiovasc Surg, 2017, 154(1): 81-86.
9.	Berretta P, Trimarchi S, Patel HJ, <italic>et al</italic>. Malperfusion syndromes in type A aortic dissection: What we have learned from IRAD. J Vis Surg, 2018, 4: 65.
10.	Biagini E, Lofiego C, Ferlito M, <italic>et al</italic>. Frequency, determinants, and clinical relevance of acute coronary syndrome-like electrocardio-graphic findings in patients with acute aortic syndrome. Am J Cardiol, 2007, 100(6): 1013-1019.
11.	Chen YF, Chien TM, Yu CP, <italic>et al</italic>. Acute aortic dissection type A with acute coronary involvement: A novel classification. Int J Cardiol, 2013, 168(4): 4063-4069.
12.	孙立忠, 朱俊明, 刘永民, 等主编. 主动脉外科学. 第 2 版. 北京: 人民卫生出版社, 2015. 265-266.
13.	Kreibich M, Bavaria JE, Branchetti E, <italic>et al</italic>. Management of patients with coronary artery malperfusion secondary to type A aortic dissection. Ann Thorac Surg, 2019, 107(4): 1174-1180.
14.	刘雁翔, 孙晓刚. 急性 Stanford A 型主动脉夹层累及冠状动脉的研究进展. 中华胸心血管外科杂志, 2017, 33(10): 628-631.
15.	Rosenblum JM, Leshnower BG, Moon RC, <italic>et al</italic>. Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 157(1): 14-23.
16.	Yang B, Norton EL, Hobbs R, <italic>et al</italic>. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J Thorac Cardiovasc Surg, 2019, 157(6): 2125-2136.

1. Wang T, Wei D, Evans T, et al. Surgery for type A aortic dissection: 14-year contemporary cohort study. Heart Lung Circ, 2020, [Epub ahead of print].
2. Uchida K, Karube N, Minami T, <italic>et al</italic>. Treatment of coronary malperfusion in type A acute aortic dissection. Gen Thorac Cardiovasc Surg, 2018, 66(11): 621-625.
3. 郭世超, 孙立忠, 朱俊明, 等. 保留自体头臂血管的孙氏手术在急性主动脉夹层中的应用. 中国胸心血管外科临床杂志, 2018, 25(6): 512-515.
4. Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
5. Imoto K, Uchida K, Karube N, <italic>et al</italic>. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg, 2013, 44(3): 419-424.
6. Girdauskas E, Kuntze T, Borger MA, <italic>et al</italic>. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
7. Salmasi MY, Al-Saadi N, Hartley P, <italic>et al</italic>. The risk of misdiagnosis in acute thoracic aortic dissection: A review of current guidelines. Heart, 2020, 106(12): 885-891.
8. Narayan P, Rogers CA, Benedetto U, <italic>et al</italic>. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection. J Thorac Cardiovasc Surg, 2017, 154(1): 81-86.
9. Berretta P, Trimarchi S, Patel HJ, <italic>et al</italic>. Malperfusion syndromes in type A aortic dissection: What we have learned from IRAD. J Vis Surg, 2018, 4: 65.
10. Biagini E, Lofiego C, Ferlito M, <italic>et al</italic>. Frequency, determinants, and clinical relevance of acute coronary syndrome-like electrocardio-graphic findings in patients with acute aortic syndrome. Am J Cardiol, 2007, 100(6): 1013-1019.
11. Chen YF, Chien TM, Yu CP, <italic>et al</italic>. Acute aortic dissection type A with acute coronary involvement: A novel classification. Int J Cardiol, 2013, 168(4): 4063-4069.
12. 孙立忠, 朱俊明, 刘永民, 等主编. 主动脉外科学. 第 2 版. 北京: 人民卫生出版社, 2015. 265-266.
13. Kreibich M, Bavaria JE, Branchetti E, <italic>et al</italic>. Management of patients with coronary artery malperfusion secondary to type A aortic dissection. Ann Thorac Surg, 2019, 107(4): 1174-1180.
14. 刘雁翔, 孙晓刚. 急性 Stanford A 型主动脉夹层累及冠状动脉的研究进展. 中华胸心血管外科杂志, 2017, 33(10): 628-631.
15. Rosenblum JM, Leshnower BG, Moon RC, <italic>et al</italic>. Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2019, 157(1): 14-23.
16. Yang B, Norton EL, Hobbs R, <italic>et al</italic>. Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience. J Thorac Cardiovasc Surg, 2019, 157(6): 2125-2136.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Experience for 107 patients with acute type A aortic dissection involving coronary arteries

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