title: Surgical management of coronary malperfusion due to type a aortic dissection.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. erenerus@yahoo.com
authors.forename: Ercan
authors.initials: E
authors.lastname: Eren
authors.forename: Mehmet E
authors.initials: ME
authors.lastname: Toker
authors.forename: Altuğ
authors.initials: A
authors.lastname: Tunçer
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Keles
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Erdogan
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Anasiz
authors.forename: Mustafa
authors.initials: M
authors.lastname: Güler
authors.forename: Mehmet
authors.initials: M
authors.lastname: Balkanay
authors.forename: Gökhan
authors.initials: G
authors.lastname: Ipek
authors.forename: Mete
authors.initials: M
authors.lastname: Alp
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: 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