Key result
In patients with acute type-A aortic dissection and coronary artery involvement, surgical repair with coronary artery bypass grafting for Neri type B and C lesions resulted in 21.4% in-hospital mortality compared to 8.1% for ostial reimplantation in Neri type A lesions (P=0.124), with comparable long-term survival.
Why the study?
Surgical strategies for acute type-A aortic dissection with coronary artery involvement have been controversial and their prognosis remains unclear.
Does aTAAD repair with CABG for Neri type B/C coronary involvement yield comparable outcomes to ostia reimplantation for Neri type-A involvement in patients with acute type-A aortic dissection?
Observational (n=65)
No
Does aTAAD repair with CABG for Neri type B/C coronary involvement yield comparable outcomes to ostia reimplantation for Neri type-A involvement in patients with acute type-A aortic dissection?
Absolute Event Rate: 21.4% vs 8.1%
p-value: p=0.124
In patients with acute type-A aortic dissection and coronary involvement, combined aortic repair and CABG for Neri type B/C lesions yields comparable long-term survival to ostial reimplantation for Neri type A lesions.
No significant mortality or survival difference by strategy; leaves open optimal coronary management in type A dissection with involvement.
The surgical strategies for acute type-A aortic dissection (aTAAD) with coronary artery involvement have been controversial, and its prognosis remains unclear. Thus, in this study, we aim to determine the characteristics, surgical strategies, and prognosis of patients with coronary artery involvement due to aTAAD.Retrospective analysis of 65 consecutive aTAAD patients with coronary artery involvement between September 2005 and January 2012 was performed. The patients were divided into two groups: those treated with aTAAD repair and coronary ostia reimplantation (Neri type-A, group A, n = 37) and those with aTAAD repair and coronary artery bypass grafting (Neri type B and C, group B, n = 28).Overall in-hospital mortality was determined to be 8.1% for group A and 21.4% for group B (P = 0.124). No significant difference was determined between groups A and B in cardiopulmonary bypass time, cross-clamp time, cerebral perfusion time, and hospitalization time. Intensive care unit (ICU) stay was 5.8 ± 7.4 days for group A, whereas it was 12.4 ± 10.6 days for group B (P = 0.009). The morbidity of postoperative temporary and permanent neurological dysfunction was similar between the two groups, while renal and respiratory dysfunction were 8.1% versus 25.0% and 16.2% versus 39.3%, respectively (P = 0.062, P = 0.036). Average follow-up time was 112.0 ± 44.8 months, and survival curves have not shown statistical significance between two groups (P = 0.386).Coronary artery dissection with Neri type B and C in acute TAAD has been associated with higher early death, but comparable long-term survival after discharge. However, combined immediate coronary artery bypass grafting and aortic repair remains a safe, effective, and acceptable approach to these challenging group of patients.
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Lu et al. (2021) conducted an observational in Acute type-A aortic dissection with coronary artery involvement (n=65). Aortic repair and coronary artery bypass grafting (Neri type B and C) vs. Aortic repair and coronary ostia reimplantation (Neri type A) was evaluated on In-hospital mortality (p=0.124). In patients with acute type-A aortic dissection and coronary artery involvement, surgical repair with coronary artery bypass grafting for Neri type B and C lesions resulted in 21.4% in-hospital mortality compared to 8.1% for ostial reimplantation in Neri type A lesions (P=0.124), with comparable long-term survival.
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