Surgical treatment of Stanford type A aortic dissection after coronary artery stenting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Shichao , QIAO Zhiyu , LI Chengnan , SUN Lizhong ,  ZHU Junming

Beijing Institute of Heart, Lung and Blood Vessel Disease of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing, 100029, P. R. China;

Corresponding author：

ZHU Junming, Email: anzhenzjm@163.com

Keywords：

Aortic dissection; misdiagnosis; iatrogenic; percutaneous coronary intervention; Sun’s procedure

DOI：

10.7507/1007-4848.202203007

Video：

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Objective To retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. Methods Clinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. Results Finally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. Conclusion Iatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.

Citation： GUO Shichao, QIAO Zhiyu, LI Chengnan, SUN Lizhong, ZHU Junming. Surgical treatment of Stanford type A aortic dissection after coronary artery stenting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 111-115. doi: 10.7507/1007-4848.202203007 Copy

1.	Morjan M, Reser D, Savic V, et al. Concomitant coronary artery bypass in patients with acute type A aortic dissection. Semin Thorac Cardiovasc Surg, 2022, 34(2): 410-416.
2.	Berretta P, Trimarchi S, Patel HJ, et al. Malperfusion syndromes in type A aortic dissection: What we have learned from IRAD. J Vis Surg, 2018, 4: 65.
3.	Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the International Registry of Acute Aortic Dissection: A 20-year experience of collaborative clinical research. Circulation, 2018, 137(17): 1846-1860.
4.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
5.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
6.	Núñez-Gil IJ, Bautista D, Cerrato E, et al. Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or interventional coronary procedures. Circulation, 2015, 131(24): 2114-2119.
7.	王龙飞, 刘宁宁, 李宇, 等. 导管相关的医源性主动脉夹层及主动脉壁间血肿临床治疗经验. 心肺血管病杂志, 2019, 38(4): 391-394.
8.	Dunning DW, Kahn JK, Hawkins ET, et al. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv, 2000, 51(4): 387-393.
9.	温伟, 张新超. 误诊疾病数据库单病种误诊文献研究: 主动脉夹层. 临床误诊误治, 2015, 28(5): 1-4.
10.	Zschaler S, Schmidt G, Kukucka M, et al. How to prevent inadvertent emergency anticoagulation in acute type A aortic dissection: When in doubt, don't. Cardiovasc Diagn Ther, 2018, 8(6): 805-810.
11.	肖付诚, 葛翼鹏, 里程楠, 等. 术前双重抗血小板对急性A型主动脉夹层术后早期的影响. 中华胸心血管外科杂志, 2019, (12): 735-738.
12.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
13.	Girardi LN, Krieger KH, Lee LY, et al. Management strategies for type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg, 2004, 77(4): 1309-1314.
14.	Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
15.	Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.

1. Morjan M, Reser D, Savic V, et al. Concomitant coronary artery bypass in patients with acute type A aortic dissection. Semin Thorac Cardiovasc Surg, 2022, 34(2): 410-416.
2. Berretta P, Trimarchi S, Patel HJ, et al. Malperfusion syndromes in type A aortic dissection: What we have learned from IRAD. J Vis Surg, 2018, 4: 65.
3. Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the International Registry of Acute Aortic Dissection: A 20-year experience of collaborative clinical research. Circulation, 2018, 137(17): 1846-1860.
4. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
5. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
6. Núñez-Gil IJ, Bautista D, Cerrato E, et al. Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or interventional coronary procedures. Circulation, 2015, 131(24): 2114-2119.
7. 王龙飞, 刘宁宁, 李宇, 等. 导管相关的医源性主动脉夹层及主动脉壁间血肿临床治疗经验. 心肺血管病杂志, 2019, 38(4): 391-394.
8. Dunning DW, Kahn JK, Hawkins ET, et al. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv, 2000, 51(4): 387-393.
9. 温伟, 张新超. 误诊疾病数据库单病种误诊文献研究: 主动脉夹层. 临床误诊误治, 2015, 28(5): 1-4.
10. Zschaler S, Schmidt G, Kukucka M, et al. How to prevent inadvertent emergency anticoagulation in acute type A aortic dissection: When in doubt, don't. Cardiovasc Diagn Ther, 2018, 8(6): 805-810.
11. 肖付诚, 葛翼鹏, 里程楠, 等. 术前双重抗血小板对急性A型主动脉夹层术后早期的影响. 中华胸心血管外科杂志, 2019, (12): 735-738.
12. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
13. Girardi LN, Krieger KH, Lee LY, et al. Management strategies for type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg, 2004, 77(4): 1309-1314.
14. Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
15. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of Stanford type A aortic dissection after coronary artery stenting

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