Proximal aortic dissection with coronary malperfusion

Presentation, management, and outcome

Eugenio Neri, Thomas Toscano, Ugo Papalia, Giacomo Frati, Massimo Massetti, Gianni Capannini, Enrico Tucci, Dimitri Buklas, Luigi Muzzi, Luca Oricchio, Carlo Sassi

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background: Acute myocardial ischemia and infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. Surgical treatment of these patients relies on the re-establishment of an adequate coronary blood flow and on the rescue of jeopardized myocardium. This article reports the results of a selected group of 24 patients with type A acute aortic dissection and coronary artery dissection. We review our experience and illustrate our approach to this condition, which evolved over a 15-year period. Methods: Between July 1985 and March 2000, 24 patients from a total of 211 (11.3%) treated for acute type A aortic dissection had dissection of at least one of the coronary ostia. There were 14 men and 10 women. The mean age was 65.5 years (median 61.7; range 41-78 years). The right coronary artery was involved in 11 patients, the left in 4 patients, and both coronary arteries in 9 patients. At admission, 16 patients had Q waves (66%), inferior in 6 (25%) and anterior, lateral, septal, or posterior in 10 (41%). All procedures were done on an emergency basis within 10 hours (median 4 hours) after initial chest pain and within 2 hours after the patient's arrival. Results: Hospital mortality was 20% (5 patients); 3 patients could not be weaned from cardiopulmonary bypass and died intraoperatively, and 2 patients died postoperatively of low cardiac output. Conclusions: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

Original languageEnglish
Pages (from-to)552-560
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume121
Issue number3
DOIs
Publication statusPublished - 2001

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Dissection
Coronary Vessels
Low Cardiac Output
Hospital Mortality
Chest Pain
Cardiopulmonary Bypass
Resuscitation
Myocardial Ischemia
Myocardium
Emergencies
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Proximal aortic dissection with coronary malperfusion : Presentation, management, and outcome. / Neri, Eugenio; Toscano, Thomas; Papalia, Ugo; Frati, Giacomo; Massetti, Massimo; Capannini, Gianni; Tucci, Enrico; Buklas, Dimitri; Muzzi, Luigi; Oricchio, Luca; Sassi, Carlo.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 121, No. 3, 2001, p. 552-560.

Research output: Contribution to journalArticle

Neri, E, Toscano, T, Papalia, U, Frati, G, Massetti, M, Capannini, G, Tucci, E, Buklas, D, Muzzi, L, Oricchio, L & Sassi, C 2001, 'Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome', Journal of Thoracic and Cardiovascular Surgery, vol. 121, no. 3, pp. 552-560. https://doi.org/10.1067/mtc.2001.112534
Neri, Eugenio ; Toscano, Thomas ; Papalia, Ugo ; Frati, Giacomo ; Massetti, Massimo ; Capannini, Gianni ; Tucci, Enrico ; Buklas, Dimitri ; Muzzi, Luigi ; Oricchio, Luca ; Sassi, Carlo. / Proximal aortic dissection with coronary malperfusion : Presentation, management, and outcome. In: Journal of Thoracic and Cardiovascular Surgery. 2001 ; Vol. 121, No. 3. pp. 552-560.
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AU - Neri, Eugenio

AU - Toscano, Thomas

AU - Papalia, Ugo

AU - Frati, Giacomo

AU - Massetti, Massimo

AU - Capannini, Gianni

AU - Tucci, Enrico

AU - Buklas, Dimitri

AU - Muzzi, Luigi

AU - Oricchio, Luca

AU - Sassi, Carlo

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N2 - Background: Acute myocardial ischemia and infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. Surgical treatment of these patients relies on the re-establishment of an adequate coronary blood flow and on the rescue of jeopardized myocardium. This article reports the results of a selected group of 24 patients with type A acute aortic dissection and coronary artery dissection. We review our experience and illustrate our approach to this condition, which evolved over a 15-year period. Methods: Between July 1985 and March 2000, 24 patients from a total of 211 (11.3%) treated for acute type A aortic dissection had dissection of at least one of the coronary ostia. There were 14 men and 10 women. The mean age was 65.5 years (median 61.7; range 41-78 years). The right coronary artery was involved in 11 patients, the left in 4 patients, and both coronary arteries in 9 patients. At admission, 16 patients had Q waves (66%), inferior in 6 (25%) and anterior, lateral, septal, or posterior in 10 (41%). All procedures were done on an emergency basis within 10 hours (median 4 hours) after initial chest pain and within 2 hours after the patient's arrival. Results: Hospital mortality was 20% (5 patients); 3 patients could not be weaned from cardiopulmonary bypass and died intraoperatively, and 2 patients died postoperatively of low cardiac output. Conclusions: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

AB - Background: Acute myocardial ischemia and infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. Surgical treatment of these patients relies on the re-establishment of an adequate coronary blood flow and on the rescue of jeopardized myocardium. This article reports the results of a selected group of 24 patients with type A acute aortic dissection and coronary artery dissection. We review our experience and illustrate our approach to this condition, which evolved over a 15-year period. Methods: Between July 1985 and March 2000, 24 patients from a total of 211 (11.3%) treated for acute type A aortic dissection had dissection of at least one of the coronary ostia. There were 14 men and 10 women. The mean age was 65.5 years (median 61.7; range 41-78 years). The right coronary artery was involved in 11 patients, the left in 4 patients, and both coronary arteries in 9 patients. At admission, 16 patients had Q waves (66%), inferior in 6 (25%) and anterior, lateral, septal, or posterior in 10 (41%). All procedures were done on an emergency basis within 10 hours (median 4 hours) after initial chest pain and within 2 hours after the patient's arrival. Results: Hospital mortality was 20% (5 patients); 3 patients could not be weaned from cardiopulmonary bypass and died intraoperatively, and 2 patients died postoperatively of low cardiac output. Conclusions: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

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