Short-term outcomes of acute coronary involvement in type A aortic dissection without myocardial ischemia: a multiple center retrospective cohort study

Wang, Maozhou; Fan, Ruixin; Gu, Tingting; Zhang, Zonggang; Liu, Zhonghong; Qiao, Chenhui; Sun, Li‐Zhong; Gong, Ming; Li, Haiyang; Zhang, Hongjia

doi:10.1186/s13019-021-01469-z

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…In Table 1 , we can see 45 patients (77.6%) had myocardial ischemia in Group I while none in Group II. Meanwhile, some authors ( 22 , 23 ) argued that concomitant CABG was not a risk factor for hospital morality with aortic repair. Okada et al ( 23 ) thought patients with concomitant CABG have more preoperative comorbidities, which may adversely affect outcomes, and which may therefore deserve special attention.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement

et al. 2022

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BackgroundCoronary artery (CA) involvement due to acute aortic dissection (AAD) is a catastrophic cardiovascular disease with high mortality. Two main surgery strategies, local coronary repair and coronary artery bypass grafting (CABG) can be applied to reestablish the blood flow in the aortic repair. This study was to evaluate the operative and long-term outcomes of type A AAD patients, who received aortic dissection repair plus CABG or local coronary repair.MethodWe reviewed our database and screened 148 type A AAD patients with CA involvement from January 2001 to December 2021. Local coronary repair or CABG was performed concomitantly on these enrolled patients.ResultsAt the time of aortic repair, there were 58 patients with concomitant CABG (Group I) and 90 patients with local coronary repair (Group II). The basal characteristics of these two groups had no difference, except for acute myocardial ischemia (AMI) and CA involvement type. 45 patients with AMI in Group I, but none in Group II (P < 0.001). There was a higher frequency of type B and C lesions of CA involvement in Group I than that in Group II (P < 0.001). There was no difference in surgical procedures and complications, except for postoperative acute kidney injury (AKI) (34.5% vs. 8.9%, P < 0.001). Hospital mortality in Group I was higher than that in Group II, but without statistical difference (20.7% vs. 11.1%, P = 0.155). No significant difference was obtained in long-term survival rate between the two groups (82.5 ± 4.8% vs. 81.2 ± 6.9%, P = 0.19).ConclusionCABG and local coronary repair suits different types of CA involvement, and their effects on perioperative results and long-term survival for type A AAD patients with CA involvement are equal.

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Section: Discussionmentioning

confidence: 99%

Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement

et al. 2022

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“…Chinese ATAAD patients were younger than those in Europe and North America (7,9,10,26). Thus, the TAR + FET, as a one-stage repair technique, has become a routine procedure to facilitate future surgery for the distal aorta (25)(26)(27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has reported the predictive risk factors for postoperative AKI, including age, gender, body mass index, hypertension, left ventricular ejection fraction, preoperative SCr, CPB time, perioperative sepsis, thoracotomy exploration, and coronary involvement (7,9,10,(28)(29)(30). Nevertheless, there is no agreement on it yet.…”

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury (AKI) patients after aortic surgery have a considerably worse short-and long-term prognosis, resulting in a higher risk of mortality and major adverse outcomes (6). AKI incidence after thoracic aortic surgery varies between 26.0-77.6%, depending on different definitions of AKI and confounding patient selection (7)(8)(9)(10)(11)(12)(13)(14). Severe AKI (AKI stage 3) is associated with higher postoperative mortality, more renal replacement therapy (RRT) treatments, and longer intensive care unit (ICU) stays for patients than in nonsevere AKI individuals (8,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for severe acute kidney injury post complication after total arch replacement combined with frozen elephant trunk, in acute type A aortic dissection

Chen¹,

Chen²,

Chen³

et al. 2022

Cardiovasc Diagn Ther

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Background: Total arch replacement with the frozen elephant trunk (TAR + FET) technique is a challenging approach for acute type A aortic dissection (ATAAD). Severe acute kidney injury (AKI) adversely affects the prognosis of hospitalized patients. The study aims to evaluate the incidence and risk factors of severe AKI. Methods:We conducted a retrospective cross-sectional study of the records of ATAAD patients following TAR + FET, admitted between January 2013 and December 2018. A multivariate logistic regression model was used to identify predictors of severe postoperative AKI. Severe postoperative AKI was defined using the Kidney Disease Improving Global Outcomes criteria. Results:The whole in-hospital mortality rate was 4.3%. Among 670 patients, major adverse outcomes were present in 169 patients (25.2%), 67 patients (10.0%) required renal replacement therapy (RRT), and 80 (11.9%) developed severe postoperative AKI. In-hospital mortality in the severe AKI group (13.8%) was 4.5 times higher than in the non-severe AKI group (3.1%). Compared with the non-severe AKI patients, the severe AKI patients had a higher incidence of major adverse outcomes (100% vs. 15.1%, P<0.001) and more frequent use of RRT (83.8% vs. 0.0%, P<0.001). Multivariate analysis revealed that severe postoperative AKI was predicted by advanced age [odds ratio (OR) =1.

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“…Some patients with Stanford type A aortic dissection (STAAD) may have coronary artery problems, such as coronary artery involvement or coronary atherosclerotic heart disease (1)(2)(3). In addition, some patients with myocardial ischaemia or even myocardial infarction show significantly increased early mortality (3,4).…”

Section: Introductionmentioning

confidence: 99%

Mid-term Patency of the Great Saphenous Bypass to Aorta vs. Non-aortic Arteries in Stanford Type A Aortic Dissection Surgery With Concomitant CABG

Wang

Jia

et al. 2021

Front. Cardiovasc. Med.

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Background: Stanford type A aortic dissection (STAAD) is often associated with coronary artery problems requiring coronary artery bypass grafting (CABG). However, the prognosis of different proximal graft locations remains unclear.Methods: From May 2015 to April 2020, 62 patients with acute STAAD who underwent aortic surgery concomitant with CABG were enrolled in our study. Aortic bypass was defined as connecting the proximal end of the vein bridge to the artificial aorta (SVG-AO); non-aortic bypass was defined as connecting the proximal end of the vein bridge to a non-aorta vessel, including left subclavian artery, left common carotid artery, and right brachiocephalic artery (non-SVG-AO). We compared early- and mid-term results between patients in the above two groups. Early results included death and bleeding, and mid-term results graft patency, aortic-related events, and bleeding. Grafts were evaluated by post-operative coronary computed tomography angiography. According to the Fitzgibbon classification, grade A (graft stenosis <50%) is considered a patent graft. Univariate and multivariate analyses were performed to assess differences between aortic and non-aortic bypass in STAAD.Results: SVG-AO and non-SVG-AO were performed in 15 and 47 patients, respectively. There was no significant difference in death (log-rank test, p = 0.426) or bleeding (p = 0.766) between the two groups in the short term. One year of follow-up was completed in 37 patients (eight in the SVG-AO group and 29 in the non-SVG-AO group), among which 14/15 (93.3%) grafts were patent in the SVG-AO group and 32/33 (97.0%) grafts in the non-SVG-AO at 1 week, without a significant difference (p = 0.532). At 3 months, 12/13 (92.3%) grafts were patent in the SVG-AO group and 16/32 (50.0%) grafts in the non-SVG-AO, with a significant difference (p = 0.015), and 12/13 (92.3%) grafts in the SVG-AO group and 15/32 (46.9%) grafts in the non-SVG-AO group were patents, with a significant difference. Multivariate analysis showed proximal aortic bypass and dual anticoagulation to be protective factors for the 1-year patency of grafts.Conclusion: In patients requiring aortic dissection surgery with concomitant CABG, no differencess' between SVG-AO and SVG-non-AO in early outcomes were detected, but SVG-AO may have higher mid-term patency.

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Short-term outcomes of acute coronary involvement in type A aortic dissection without myocardial ischemia: a multiple center retrospective cohort study

Cited by 6 publications

References 28 publications

Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement

Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement

Risk factors for severe acute kidney injury post complication after total arch replacement combined with frozen elephant trunk, in acute type A aortic dissection

Mid-term Patency of the Great Saphenous Bypass to Aorta vs. Non-aortic Arteries in Stanford Type A Aortic Dissection Surgery With Concomitant CABG

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