title: Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS).
abstract: BACKGROUND
  Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.
  
  
  METHODS
  We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.
  
  
  RESULTS
  Retrospective review of CT images showed coronary abnormalities in 83% (n=5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n=4) due to left heart failure and in 33% (n=2) due to right heart failure. Thirty day mortality was 67% (n=4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.
  
  
  CONCLUSIONS
  Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Sabina P W
authors.initials: SP
authors.lastname: Guenther
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.affiliation: Department of Clinical Radiology, University Hospital Munich, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Reichelt
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Born
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003323:Coronary Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography; D018570:Risk Assessment; D016896:Treatment Outcome