AI Article Synopsis
- Myocardial ischemia in patients with acute aortic dissection type A is linked to poor outcomes due to coronary artery disease, prompting debate on the necessity of preoperative coronary angiography.
- A study analyzed six AADA patients treated with extracorporeal life support, revealing 83% had coronary abnormalities, leading to 67% undergoing unplanned bypass surgery and a high 30-day mortality rate of 67%.
- The findings emphasize the importance of assessing coronary conditions via CT scans to guide surgical decisions and highlight the potential benefits of using extracorporeal life support for myocardial recovery in select cases.
Article Abstract
Background: Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.
Methods: We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.
Results: Retrospective review of CT images showed coronary abnormalities in 83% (n=5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n=4) due to left heart failure and in 33% (n=2) due to right heart failure. Thirty day mortality was 67% (n=4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.
Conclusion: Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.
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| http://dx.doi.org/10.1532/HSF98.2014397 | DOI Listing |
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