Surgical management of coronary malperfusion due to type a aortic dissection.
BACKGROUND
Acute aortic dissection coexisting with coronary malperfusion is a relatively rare but fatal condition. Surgical treatment of these patients is to perform early coronary revascularization concomitant with aortic repair. We review our surgical results of a selected group of 14 patients with type A acute aortic dissection and coronary artery dissection.


METHODS
Between January 1993 and March 2005, 14 patients (10.2%) from a total of 136 consecutive patients with acute type A aortic dissection concomitant coronary dissection were treated by performing aortic repair and coronary artery bypass grafting. There were 11 men and 3 women (mean age, 56.7 +/- 8.4 years). The right coronary artery was involved in eight patients, the left in two patients, and both coronary arteries in four patients. At admission, nine patients had Q waves (64.2%), inferior in seven (50%) and anterior or lateral in two (14.2%).


RESULTS
Hospital mortality rate was 21.4% (3 of 14 patients). Of these, two patients could not be weaned from cardiopulmonary bypass, and one patient died of multiorgan failure in the intensive care unit.


CONCLUSIONS
Since acute type A aortic dissection with coronary involvement is associated with high mortality rate, immediate coronary artery bypass grafting and aortic repair is a safe and reliable approach to these challenging group of patients.
Eren
Ercan
E
Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. erenerus@yahoo.com
Toker
Mehmet E
ME
Tunçer
Altuğ
A
Keles
Cüneyt
C
Erdogan
Hasan B
HB
Anasiz
Hüseyin
H
Güler
Mustafa
M
Balkanay
Mehmet
M
Ipek
Gökhan
G
Alp
Mete
M
Yakut
Cevat
C
D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014656:Vascular Surgical Procedures