Experience in diagnosis and treatment of acute Stanford type A aortic dissection involving coronary arteries

Jie CHEN; JiaHao PAN; Cong NIE; Xiaolong MA; Jiawen LUO; Fei CHEN; Ming WU; Anxing HOU; Qing ZHOU; Wenwu ZHOU

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Experience in diagnosis and treatment of acute Stanford type A aortic dissection involving coronary arteries

VernacularTitle:急性Stanford A型主动脉夹层累及冠脉的诊治体会
Author: Jie CHEN ¹ ; JiaHao PAN ¹ ; Cong NIE ¹ ; Xiaolong MA ¹ ; Jiawen LUO ¹ ; Fei CHEN ¹ ; Ming WU ¹ ; Anxing HOU ¹ ; Qing ZHOU ¹ ; Wenwu ZHOU ¹
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1. 湖南省人民医院（湖南师范大学附属第一医院）心脏大血管外科，长沙　410004
Publication Type:Journal Article
Keywords: Aortic dissection; Coronary artery disease; Aortic root reconstruction; Coronary artery bypass
From: Journal of Chinese Physician 2025;27(8):1130-1134
CountryChina
Language:Chinese
Abstract: Objective:To analyze the anatomical characteristics and surgical management measures of acute Stanford type A aortic dissection (AAD) involving coronary arteries, and to preliminarily explore the clinical efficacy of different coronary artery treatment techniques.Methods:A retrospective analysis was conducted on the clinical data of 42 patients who underwent surgery for AAD involving coronary arteries in Hunan Provincial People′s Hospital from January 2022 to May 2025. They were divided into the MI group (14 cases) and the nMI group (28 cases) according to whether they had acute myocardial infarction before surgery. The clinical data such as the actual surgical methods and mortality in the two groups were summarized.Results:Among 294 surgeries, 42 cases (14.3%) had definite coronary artery involvement, including 14 cases in the MI group and 28 cases in the nMI group; 1 case had bilateral coronary artery involvement and 41 cases had right coronary artery involvement. Regarding injury types: 16 cases were of the coronary trunk compression type, 12 cases were of the sinus intimal tear neal to ostium type, and 14 cases were of the coronary trunk intimal type. There was no statistically significant difference in the types of coronary artery involvement between the two groups ( P>0.05). There were 18 cases of Sun′s procedure with preserved aortic sinus and aortic valve, 7 cases of Bentall procedure without bypass, and 17 cases of Bentall procedure plus bypass. There was no statistically significant difference in the surgical plans between the two groups ( P>0.05). There were 4 deaths within 30 days (2 cases in each group). Conclusions:AAD involving coronary arteries is a critical condition, and accurate diagnosis is somewhat difficult. Myocardial ischemia is not significantly associated with the type of coronary artery involvement. The surgical plan depends on the type of coronary artery involvement. The classification method in this study is conducive to selecting appropriate surgical methods and improving surgical prognosis.