Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection with Coronary Ostial Involvement.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-04-03 DOI:10.1016/j.athoracsur.2025.03.025

Ling-Chen Huang, Ze-Hua Shao, Yang-Xue Sun, Li-Xi Gan, Xiang-Yang Qian, Cun-Tao Yu, Hong-Wei Guo

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引用次数: 0

Abstract

Background: Acute type A aortic dissection (ATAAD) with coronary ostial involvement poses significant surgical challenges. We describe two surgical approaches to managing coronary involvement and assess their outcomes.

Methods: Between January 2019 and December 2023, 617 ATAAD patients with coronary involvement were enrolled. Based on our institutional surgical protocol, 507 patients underwent isolated coronary ostial reconstruction, whereas 110 received protective coronary artery bypass grafting (CABG) following coronary ostial reconstruction or closure in cases of severe coronary involvement (defined as Neri A with >50% ostial margin involvement, Neri B with distal entry, or Neri C). Serious adverse events were defined as operative mortality, mechanical support, or stroke. Logistic regression identified factors associated with serious adverse events.

Results: Operative mortality occurred in 23 patients (3.73%), and 44 patients (7.13%) experienced serious adverse events. Despite more severe coronary involvement (P<0.001) and coronary malperfusion (P<0.001) at baseline, the protective CABG group showed significantly lower procedural myocardial injury (2.73% vs. 9.27%, P=0.037) and a trend toward fewer serious adverse events (2.73% vs. 8.09%, P=0.076). Logistic regression identified that protective CABG was associated with a reduced risk of serious adverse events (odds ratio:0.24, 95%confidence interval:0.07-0.86, P=0.028). The median follow-up was 25.95 months. Kaplan-Meier analysis revealed no significant difference in cumulative survival between the two groups (log-rank P=0.70).

Conclusions: Our institutional surgical protocol demonstrates safety and effectiveness. The protective CABG approach was associated with a reduced risk of serious adverse events without impacting overall survival, supporting its more aggressive use in ATAAD with severe coronary involvement.

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保护性冠状动脉旁路移植术改善急性A型主动脉夹层冠状动脉口受累的手术效果。

背景：急性A型主动脉夹层（ATAAD）伴冠状动脉口受累是一项重大的手术挑战。我们描述了两种手术方法来管理冠状动脉受累和评估他们的结果。方法：在2019年1月至2023年12月期间，纳入了617例冠状动脉受累的ATAAD患者。根据我们的机构手术方案，507名患者接受了孤立的冠状动脉口重建，而110名患者在冠状动脉口重建或关闭后接受了保护性冠状动脉旁路移植术（CABG），这是在严重冠状动脉受损伤的情况下（定义为Neri A与bbb50 50%的口缘受损伤，Neri B与远端入口，或Neri C）。严重的不良事件定义为手术死亡率，机械支持或中风。Logistic回归确定了与严重不良事件相关的因素。结果：手术死亡23例（3.73%），严重不良事件44例（7.13%）。结论：我们的机构手术方案证明了安全性和有效性。保护性冠状动脉搭桥入路与严重不良事件风险降低相关，且不影响总生存期，支持其在严重冠脉累及的ATAAD中更积极地使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.