Key result
Coronary artery involvement in patients with acute type A aortic dissection increased in-hospital mortality, but short-term survival after discharge was similar to those without involvement (P=0.146).
Why the study?
Coronary artery involvement remains a fatal comorbidity in acute type A aortic dissection, prompting evaluation of its impact on perioperative and short-term outcomes after total arch replacement and frozen elephant trunk implantation.
Does coronary artery involvement impact perioperative and short-term outcomes in patients with acute type A aortic dissection undergoing total arch replacement and frozen elephant trunk implantation?
Cohort (n=204)
Does coronary artery involvement impact perioperative and short-term outcomes in patients with acute type A aortic dissection undergoing total arch replacement and frozen elephant trunk implantation?
p-value: p=0.146
Coronary artery involvement in acute type A aortic dissection increases in-hospital mortality risk, primarily due to malperfusion, but does not significantly impact short-term survival post-discharge.
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: 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.
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Wang et al. (2023) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=204). Coronary artery involvement (CAI) vs. No coronary artery involvement (non-CAI) was evaluated on Short-term survival (p=0.146). Coronary artery involvement in patients with acute type A aortic dissection increased in-hospital mortality, but short-term survival after discharge was similar to those without involvement (P=0.146).
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