Surgical repair of acute type A aortic dissection with concomitant coronary artery bypass grafting: surgical indication and strategy

Abstract

Objective To analyze the indication and strategy of concomitant coronary artery bypass grafting(CABG) during repair of acute type A aortic dissection. Methods Between February 2009 and December 2012, among 355 patients with acute type A aortic dissection repair, 21(5.9%) underwent concomitant CABG using saphenous vein grafts. Mean age was(50.3±10.2) years and 14 were males. Indications were coronary dissection in 15 patients(Neri type A in 1, type B in 2, type C in 12), preexisting coronary artery disease in 5, and coronary compression in 1. Twenty-three vein grafts were performed to bypass the right coronary and left anterior descending artery. Aortic repair included Sun's procedure in 19 cases and hemiarch replacement in 1. Results The time of cardiopulmonary bypass and aortic clamp averaged(252.5±76.9) min and(134.9±43.8) minutes respectively. Five early deaths occurred due to ventricular fibrillation in 1 patient, low cardiac output syndrome and multiorgan failure, each in 2. Mortality in CABG group was 23.8%(5/21), while 6.0%(20/334) in isolated aortic repair group(P=0.002). Paraplegia and paraparesis occurred, each in one patient. No late cardiovascular events occurred at(37.8±11.4) months. Conclusion Surgical repair for acute type A aortic dissection with concomitant CABG was associated with higher perioperative mortality. During acute type A aortic dissection repair, concomitant CABG is indicated in patients with type B or C dissected coronary arteries, and hemodynamic compromise due to preexisting coronary artery disease or coronary compression. Key words: Aortic dissection; Coronary artery bypass grafting; Cardiac surgical procedures; Indication