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 1,168 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.
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