Surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion

Abstract

Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion. Methods From January 2010 to November 2015, 307 patients of acute Stanford A aortic dissection underwent operation were included. The mean age was(51.3±13.0) years, ranged from 22 to 83. The BMI was(25.4±3.7) kg/m2 and 239(77.9%) were men. There were 210(71.2%) with hypertension, 9(2.9%) with Marfan syndrome, and 44(14.3%) with cardiac tamponade. Coronary malperfusion was confirmed in 43(14.0%) patients with 34 in right coronary artery, 5 in left coronary artery, and 4 in both. There were 26 type A, 8 type B, 9 type C in Neri system. We performed coronary ostia repair in 12 patients, Bentall in 16, coronary artery bypass grafting(CABG) in 9, and Bentall plus CABG in 6. CABG was also performed in 1 Bentall, 1 aortic valve repair, and 5 ascending aorta replacement in 264 patients without coronary malperfusion. Results The rate of CABG, cardiopulmonary bypass(CPB) time, aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P<0.01). The in-hospital mortality was 32.6% in patients with coronary malperfusion and 14.4% in patients without coronary malperfusion. Thus, coronary malperfusion significantly increased in-hospital mortality(P<0.01). The mean follow-up time was(19.2±18.0) months with a 95% follow-up rate. The total follow-up survival rate is 97.5% and the rate of patients with coronary malperfusion is 100%. Multivariate logistic regression analysis shows that cardiac tamponade(OR=4.8, P<0.01) and CPB time(OR=1.0, P<0.01) was the independent risk factor of post-operation in-hospital mortality of acute Stanford A aortic dissection. Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly. The treatment strategy depends on the specific clinical condition. Key words: Aortic dissection; Coronary malperfusion; Ssurgical operation