Key result
CABG for complex lesions and ostial repair for simple lesions yield comparable acute aortic dissection mortality.
Why the study?
The study was conducted to introduce a new, simple classification and management strategy for coronary artery involvement in aortic dissection and evaluate its outcomes.
Does a classification-based surgical management strategy yield satisfactory outcomes in patients with coronary artery involvement in acute aortic dissection?
Cohort (n=267)
No
Does a classification-based surgical management strategy yield satisfactory outcomes in patients with coronary artery involvement in acute aortic dissection?
Absolute Event Rate: 18.5% vs 9.6%
p-value: p=0.28
A simple classification of coronary artery involvement in acute aortic dissection into simple and complex lesions guides appropriate surgical management (ostial repair vs CABG) with satisfactory early and long-term survival.
Classification-guided coronary repair may be reasonable in acute aortic dissection; leaves open need for randomized confirmation.
BACKGROUND: To introduce a new and simple classification and management of coronary artery involvement in aortic dissection and report results. METHODS: Coronary artery involvement was classified into two types according to the integrity of coronary intima: simple lesion (type S) and complex lesion (type C). Complex lesions were treated by CABG and simple lesions were treated by ostial repair or reimplantation. Data were collected and analyzed retrospectively. RESULTS: From January 2010 to December 2019, 267 consecutive patients were enrolled in the study, and among them complex lesions occurred in 27 patients (11.1%) and simple lesions was found in 240 patients(89.9%). Eleven untreated vessels with simple lesion were found to be involved again in the same operation and treated by CABG. The two type groups had comparable operative mortality (type S vs. type C, 9.6% vs. 18.5%, P = 0.28). 221 patients received follow-up with a median duration of 52 months. The overall survival rates at 1, 5, and 10 years postoperatively were 88.9%, 85.7%, and 79.8% in type S group and 79.2%, 79.2%, and 79.2% in type C group, respectively (P = 0.47). For the patients who received CABG and survived at discharge, radiographic follow-up with a median duration of 28 (IQR 7-55.5) months showed the freedom from occlusion of vein graft at 1, 5, and 10 years postoperatively were 87.5%, 70.0%, 28.0%. CONCLUSIONS: According to the new classification, two types of lesions could be treated by corresponding methods with satisfactory early and long-term results. Unrepaired coronary artery was at a risk of re-involvement. Vein graft onto arteries without atherosclerosis still had a high occlusion rate.
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Chang et al. (2023) conducted a cohort in Acute type A aortic dissection with coronary artery involvement (n=267). Complex coronary lesion (type C) managed with CABG vs. Simple coronary lesion (type S) managed with ostial repair or reimplantation was evaluated on Operative mortality (within 30 days) (p=0.28). Complex coronary lesions treated with CABG and simple lesions treated with ostial repair in acute aortic dissection had comparable operative mortality (18.5% vs 9.6%, p=0.28) and long-term survival.
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