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

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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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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

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, 121(3), 552-560. https://doi.org/10.1067/mtc.2001.112534