Surgical management and outcomes of coronary artery involvement secondary to acute type A aortic dissection: a retrospective cohort study

Hanzhang Wang; Bo Jia; Yongliang Zhong; Suwei Chen; Cheng Luo; Zhiyu Qiao; Yipeng Ge; Chengnan Li; Yongmin Liu; Junming Zhu

doi:10.21037/jtd-23-990

Surgical management and outcomes of coronary artery involvement secondary to acute type A aortic dissection: a retrospective cohort study

J Thorac Dis. 2023 Dec 30;15(12):6436-6446. doi: 10.21037/jtd-23-990. Epub 2023 Nov 23.

Authors

Hanzhang Wang^#¹, Bo Jia^#¹, Yongliang Zhong¹, Suwei Chen¹, Cheng Luo¹, Zhiyu Qiao¹, Yipeng Ge¹, Chengnan Li¹, Yongmin Liu¹, Junming Zhu¹

Affiliation

¹ Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background: Coronary artery involvement (CAI) remains a fatal comorbidity in the context of acute type A aortic dissection (ATAAD). We evaluated the impact of CAI on the perioperative and short-term outcomes of patients with ATAAD who underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation and shared our surgical management experience with the involved coronary artery.

Methods: In this retrospective cohort study, a total of 204 patients with ATAAD between June 2019 and December 2021 were enrolled and divided into the CAI group (n=67) and the non-CAI group (n=137). The characteristics of CAI lesions were described according to the Neri classification. Univariable and multivariable analyses were used to identify independent risk factors for in-hospital mortality. Survival analysis was performed using the Kaplan-Meier method and compared using the log-rank test.

Results: Patients in the CAI group had a longer intraoperative duration of cardiopulmonary bypass (CPB) and cross-clamp, and experienced longer mechanical ventilation time and intensive care unit stays postoperatively. Regarding perioperative outcomes, the prevalence rates of new-onset continuous renal replacement therapy requirement (23.9% vs. 10.2%, P=0.01) and in-hospital mortality (17.9% vs. 7.3%, P=0.02) were higher in the CAI group. Coronary artery malperfusion (CAM) was an independent risk factor for in-hospital mortality. Short-term survival analysis was similar between the two groups (P=0.146).

Conclusions: For patients with ATAAD undergoing TAR and FET implantation, concomitant CAI may complicate surgery and increase in-hospital morbidity and mortality. CAM secondary to CAI was identified as an independent risk factor. However, short-term survival after hospital discharge was comparable between the two groups. Coronary ostium repair is quick and operable for both type A and type B lesions, while optimal management still warrants further investigation.

Keywords: Aortic dissection; coronary artery involvement (CAI); coronary artery malperfusion (CAM); frozen elephant trunk (FET); total arch replacement (TAR).