[Clinical profiles and surgical outcomes of coronary obstruction due to type A aortic dissection: a single institution experience].
OBJECTIVE
To investigate the clinical profile of myocardial infarction (MI) due to retrograde aortic dissection of aortic root and the relevant predictors of in-hospital death.


METHODS
The clinical data of 207 consecutive patients with type A aortic dissection (AD), who were hospitalized and underwent operation between December 2003 and October 2007, were analyzed retrospectively.


RESULTS
Eight of the 207 patients were diagnosed as with MI due to retrograde aortic dissection of aortic root, 6 males and 2 females, aged (49 +/- 14). Surgical repair of the aorta and coronary revascularization was implanted: ascending aorta replacement in 2 cases, hemi-arch replacement in 5 cases, arch replacement in 1 case; coronary artery bypass grafting in 5 cases, and coronary repair in 3 cases. In-hospital death occurred in 4 of the 8 patients (50%) who all had preoperative renal insufficiency and developed acute renal failure (ARF) after surgery. Univariate analysis identified preoperative renal insufficiency an independent predictor of in-hospital death (The preoperative serum creatinine (sCr) level of the surviving patients was (80 +/- 30) micromol/L, significantly lower than that of the deceased patients [(176 +/- 67) micromol/L, P = 0.02]. There were no significant differences in other parameters between the surviving and deceased groups.


CONCLUSIONS
MI due to type A AD is associated with high operative mortality. Preoperative renal insufficiency attributes to development of ARF after surgery and the unfavorable outcome. Renal function before surgery is essential for risk stratification in this lethal condition.
Liu
Ming
M
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Qian
Ju-ying
JY
Chen
An-qing
AQ
Hong
Tao
T
Chen
Hao
H
Zhao
Dong
D
Ding
Wen-jun
WJ
Zhao
Qiang
Q
Wang
Chun-sheng
CS
Ge
Jun-bo
JB
D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology*; D001011:Aorta / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome