Treatment of coronary malperfusion with acute type A aortic dissection

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute type A aortic dissection complicated by coronary malperfusion (n=12). Intervention: Coronary revascularization (CABG and/or PCI) concomitant with aortic repair. Primary outcome: Hospital mortality (operative death).

Q: What does this research mean for the field?

Aggressive coronary revascularization using CABG or PCI concomitant with prompt aortic repair achieves patient salvage in acute type A aortic dissection complicated by coronary malperfusion, associated with an in-hospital mortality rate of 25%. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kazuo Yamanaka; Takeshi Nishina; Senri Miwa; Keiichi Hirose; Hitoshi Sakaguchi; Akihiro Mizuno; Yukiyo Yoshida; Masashi Yada; Yohei Onga

doi:10.7793/jcoron.23.16-00011

January 1, 2017Journal of the Japanese Coronary AssociationOpen Access

Treatment of coronary malperfusion with acute type A aortic dissection

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Study Design

Type

Observational (n=12)

Multicenter

No

Structured PICO

P

Population

12 patients (mean age 65.7 years, 41.7% female) undergoing surgery for acute type A aortic dissection complicated by coronary malperfusion at a single Japanese center.

E

Exposure

Aggressive coronary revascularization (concomitant CABG in 11 cases, preoperative PCI in 2 cases, postoperative PCI in 1 case) combined with emergency central aortic repair (ascending aorta replacement in 9 cases, total aortic arch replacement in 3 cases)

O

Outcome

Hospital / operative mortalityhard clinical

Limitations

Small sample size (12 cases)
Retrospective single-center design
Unable to statistically evaluate the relationship between coronary dissection morphology and prognosis because deaths were non-cardiac and cases were few
Retrospective design
Single-center study
Small sample size (n=12)
Unable to establish a definitive association between coronary dissection morphology (Neri classification) and prognosis due to few cases and non-cardiac causes of death

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Implication

In patients with acute type A aortic dissection complicated by coronary malperfusion, early establishment of cardiopulmonary bypass, aggressive concomitant CABG (or PCI when stable), and central aortic repair achieved a 75% survival to discharge.

Abstract

年 12 月に手術を行った acute type A aortic dissection(AAAD)228 例中，冠灌流障害を併発した 12 例 5.3%(男 7 女 5，平均年齢 65.7 歳)を対象とした．冠灌流障害の原因は大動脈解離が冠動脈に波及したのが 11 例，

Discussion

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Cite This Study

Yamanaka et al. (2017) conducted an observational in Acute type A aortic dissection complicated by coronary malperfusion (n=12). Coronary revascularization (CABG and/or PCI) concomitant with aortic repair was evaluated on Hospital mortality (operative death).

synapsesocial.com/papers/6a7dc30330df0be8fb5c9b81 https://doi.org/10.7793/jcoron.23.16-00011

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Treatment of coronary malperfusion with acute type A aortic dissection

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Treatment of coronary malperfusion with acute type A aortic dissection

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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