Surgical Treatment Strategy for Acute Type A Aortic Dissection Complicated With Neri Type C Coronary Artery Involvement on the Basis of Detailed Classification
10.3969/j.issn.1009-6604.2024.11.003
- VernacularTitle:急性A型主动脉夹层合并Neri C型冠状动脉受累细化分型的外科治疗策略
- Author:
Guijun ZHU
1
;
Zhe YAN
1
;
Yang LIU
1
;
Zhiliang SONG
1
;
Bin LI
1
;
Xingpeng CHEN
1
Author Information
1. 郑州大学附属洛阳市中心医院心脏中心 洛阳市心胸外科临床研究中心,洛阳 471009
- Publication Type:Journal Article
- Keywords:
Neri classification;
Coronary artery;
Acute type A aortic dissection;
Surgical operation
- From:
Chinese Journal of Minimally Invasive Surgery
2024;24(11):731-736
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the surgical treatment strategy of acute type A aortic dissection (ATAAD) complicated with Neri type C coronary artery involvement on the basis of detailed classification.Methods Clinical data of 21 cases of ATAAD complicated with Neri type C coronary artery involvement in our hospital from November 2020 to February 2024 were retrospectively analyzed.The dissection involved the coronary artery,and the onset time was less than 1 week.Total aortic arch replacement,descending aorta stent and elephant trunk artificial vessel placement,ascending aorta replacement,and coronary artery management were performed.The treatment of detailed classification and coronary artery was as follows.Seven cases with type C1 ( local damage and rupture of coronary artery opening,partial connection with pseudolumen,and no proximal coronary involvement) were repaired with artificial material"copper coin sample";3 cases with type C2 ( severe avulsion of coronary artery opening,complete connection with pseudolumen,slight proximal involvement of coronary artery,and no sleeve formation) were replaced with 8 mm artificial vessels;11 cases with type C3 ( severe avulsion of coronary artery opening,complete connection with pseudolumen,severe proximal involvement of coronary artery,and sleeve formation) were transplanted by great saphenous vein bypass.Results Two patients died in hospital (all type C3),all of whom had difficulty in cardioversion and were given extracorporeal membrane oxygenation (ECMO) assisted circulation,and passed away on the same day and the second day after surgery,respectively.Aortic and coronary CTA were re-examined in the remaining 19 patients before discharge,and no coronary artery opening stenosis or bridge stenosis was found.Aortic and coronary CTA were re-examined at 6,12,and 18 months after surgery,respectively.The 19 patients were followed up for 6-36 months ( mean,21 months),and there were no cases of coronary artery opening stenosis or bridge stenosis.According to the New York Heart Association (NYHA) functional classification,there were 15 patients with grade Ⅰ and 4 patients with grade Ⅱ.Conclusion The detailed classification of ATAAD combined with Neri type C coronary artery involvement has guiding significance for surgical precision treatment.
