Surgical treatment of Stanford A aortic dissection involving coronary artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CUI Cong , ZHANG Li , GAO Xia , XIAO Changbo , LU Wei , WU Gang , WANG Pingfan

Henan Province Chest Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

CUI Cong, Email: conghuicui@163.com

Keywords：

Aortic dissection; coronary artery; surgical treatment

DOI：

10.7507/1007-4848.20160705

Video：

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Objective To investigate the surgical treatment and results of coronary malperfusion due to acute Stanford A aortic dissection. Methods The clinical data of 56 patients with coronary malperfusion due to type A aortic dissection, who were hospitalized and underwent operation between January 2009 and December 2016, were analyzed retrospectively. There were 39 males and 17 females at age of 26–73 (51.36±16.47) years. Results The right coronary artery was involved in 48 patients, the left in 5 patients, and both coronary arteries in 3 patients. There were 12 patients with coronary bypass grafting, 19 patients with Cabrol’s operation, 25 patients coronary artery plasty. Twelve patients died postoperatively at mortality of 21.4%. Forty-four patients survived. The patients were followed up for 3 months to 3 years. No adverse event of cardiovascular happened. Conclusion Stanford A aortic dissection with coronary involvement is associated with high mortality rate.Aggressive coronary revascularization is essential to salvage these critically ill patients. The method to reconstruct the involved coronary depends on the patients’ condition and experience of surgeon.

Citation： CUI Cong, ZHANG Li, GAO Xia, XIAO Changbo, LU Wei, WU Gang, WANG Pingfan. Surgical treatment of Stanford A aortic dissection involving coronary artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 932-936. doi: 10.7507/1007-4848.20160705 Copy

1.	Geirsson A, Szeto WY, Pochettino A, et al. Significance of malper-fusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
2.	Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
3.	Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
4.	Golledge J, Eagle KA. Acute aortic dissection. Lancet, 2008, 372(9632): 55-66.
5.	Girardi LN, Krieger KH, Lee LY, et al. Management strategies For type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg, 2004, 77(4): 1309-1314.
6.	Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoper- ative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
7.	Eren E, Toker ME, Tuncer A, et al. Surgical management of coronary malperfusion due to type A aortic dissection. J Card Surg, 2007, 22(1): 2-6.
8.	Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation, 1990, 82: IV24-38.
9.	Sail HJ, Miller CC 3^rd, Reardon MJ, et al. Operation for acute and chronic aortic disection: recent outcome with regard to neumlogic deficit and early death. Ann Thorac Surg, 1998, 66(2): 402-411.
10.	Rampoldi V, Trimarchi S, Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the international registry of acute aortic dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
11.	孙立忠, 刘宁宁, 常谦, 等. 主动脉手术并同期冠状动脉旁路移植术的临床总结. 中华外科杂志, 2006, 44(2): 76-79.
12.	Penn MS, Smedira N, Lytle B, et al. Does cornory angiography before emergency aortic surgery affect in-hospital mortality. J Am Coll Cardiol, 2000, 35(4): 889-894.
13.	Ramanath VS, Eagle KA, Nienaber CA, et al. The role of preoperative cornory angiography in the setting of type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. AM Heart J, 2011, 161(4): 790-796.
14.	洪昊. Ⅰ型急性主动脉夹层手术同期行冠状动脉旁路移植术的临床分析. 中国循环杂志, 2014, 29(z1): 105.
15.	Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to Type A aortic dissection: mechanism and surgical management. Ann Thorac Surg, 2003, 76(5): 1471-1476.
16.	Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
17.	Hsing CH, Hsieh MY, Chen WY, et al. Induction of interleukin-19 and interleukin-22 after cardiac surgery with cardiopulmonary bypass. Ann Thorac Surg, 2006, 81(6): 2196-2201.
18.	Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med, 2007, 357(11): 1121-1135.

1. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malper-fusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
2. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
3. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
4. Golledge J, Eagle KA. Acute aortic dissection. Lancet, 2008, 372(9632): 55-66.
5. Girardi LN, Krieger KH, Lee LY, et al. Management strategies For type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg, 2004, 77(4): 1309-1314.
6. Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoper- ative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
7. Eren E, Toker ME, Tuncer A, et al. Surgical management of coronary malperfusion due to type A aortic dissection. J Card Surg, 2007, 22(1): 2-6.
8. Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation, 1990, 82: IV24-38.
9. Sail HJ, Miller CC 3^rd, Reardon MJ, et al. Operation for acute and chronic aortic disection: recent outcome with regard to neumlogic deficit and early death. Ann Thorac Surg, 1998, 66(2): 402-411.
10. Rampoldi V, Trimarchi S, Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the international registry of acute aortic dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
11. 孙立忠, 刘宁宁, 常谦, 等. 主动脉手术并同期冠状动脉旁路移植术的临床总结. 中华外科杂志, 2006, 44(2): 76-79.
12. Penn MS, Smedira N, Lytle B, et al. Does cornory angiography before emergency aortic surgery affect in-hospital mortality. J Am Coll Cardiol, 2000, 35(4): 889-894.
13. Ramanath VS, Eagle KA, Nienaber CA, et al. The role of preoperative cornory angiography in the setting of type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. AM Heart J, 2011, 161(4): 790-796.
14. 洪昊. Ⅰ型急性主动脉夹层手术同期行冠状动脉旁路移植术的临床分析. 中国循环杂志, 2014, 29(z1): 105.
15. Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to Type A aortic dissection: mechanism and surgical management. Ann Thorac Surg, 2003, 76(5): 1471-1476.
16. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
17. Hsing CH, Hsieh MY, Chen WY, et al. Induction of interleukin-19 and interleukin-22 after cardiac surgery with cardiopulmonary bypass. Ann Thorac Surg, 2006, 81(6): 2196-2201.
18. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med, 2007, 357(11): 1121-1135.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of Stanford A aortic dissection involving coronary artery

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