Impact of non-significant right coronary ostial involvement on coronary events in type A aortic dissection surgery.

Abstract

Objectives: Coronary-related technical complications constantly occur during type A aortic dissection surgical repair and are potentially fatal, yet their risk factors require further investigation. The intricate morphology of coronary ostial involvement may have a substantial impact.

Methods: From June 2019 to January 2024, consecutive type A aortic dissection patients who underwent open surgery were included. Patients were divided into the coronary involvement group (non-significant involvement: Neri A-dissected intima involving the margin of the coronary ostium; significant involvement: Neri B and Neri C) and the non-involvement group. Coronary events were defined as coronary-related technical complications necessitating bailout coronary revascularization or coronary ostial repair. Logistic regression analysis identified risk factors associated with coronary events. Overall survival was estimated using Kaplan-Meier method and Cox regression analysis.

Results: Of 1168 patients, 660 patients had coronary involvement, while 508 did not. Coronary events occurred in 58 patients (4.97%), including 53 (4.54%) who required bailout coronary revascularization. Patients with coronary involvement had a higher incidence of coronary events (8.18% vs 0.79%, P < 0.001). Logistic regression analysis revealed that significant right coronary involvement was associated with coronary events (odds ratio: 20.58, 95% confidence interval: 7.37-57.50, P < 0.001). Notably, non-significant right coronary involvement, accounting for 44.61% of patients, was also associated with coronary events compared to those without involvement (odds ratio: 7.05, 95% confidence interval: 2.69-18.50, P < 0.001).

Conclusions: Coronary events occurred in 4.97% patients. Significant right coronary involvement is strongly associated with coronary events; non-significant right coronary involvement, which is relatively common in surgical patients, also poses a substantial risk for coronary events and warrants attention.