Eren Ercan, Toker Mehmet E, Tunçer Altuğ, Keles Cüneyt, Erdogan Hasan B, Anasiz Hüseyin, Güler Mustafa, Balkanay Mehmet, Ipek Gökhan, Alp Mete, Yakut Cevat
Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
J Card Surg. 2007 Jan-Feb;22(1):2-6. doi: 10.1111/j.1540-8191.2007.00331.x.
Acute aortic dissection coexisting with coronary malperfusion is a relatively rare but fatal condition. Surgical treatment of these patients is to perform early coronary revascularization concomitant with aortic repair. We review our surgical results of a selected group of 14 patients with type A acute aortic dissection and coronary artery dissection.
Between January 1993 and March 2005, 14 patients (10.2%) from a total of 136 consecutive patients with acute type A aortic dissection concomitant coronary dissection were treated by performing aortic repair and coronary artery bypass grafting. There were 11 men and 3 women (mean age, 56.7 +/- 8.4 years). The right coronary artery was involved in eight patients, the left in two patients, and both coronary arteries in four patients. At admission, nine patients had Q waves (64.2%), inferior in seven (50%) and anterior or lateral in two (14.2%).
Hospital mortality rate was 21.4% (3 of 14 patients). Of these, two patients could not be weaned from cardiopulmonary bypass, and one patient died of multiorgan failure in the intensive care unit.
Since acute type A aortic dissection with coronary involvement is associated with high mortality rate, immediate coronary artery bypass grafting and aortic repair is a safe and reliable approach to these challenging group of patients.
急性主动脉夹层合并冠状动脉灌注不良是一种相对罕见但致命的疾病。对这些患者进行手术治疗是在进行主动脉修复的同时早期进行冠状动脉血运重建。我们回顾了一组14例A型急性主动脉夹层合并冠状动脉夹层患者的手术结果。
1993年1月至2005年3月，在136例连续的A型急性主动脉夹层合并冠状动脉夹层患者中，14例（10.2%）接受了主动脉修复和冠状动脉旁路移植术治疗。其中男性11例，女性3例（平均年龄56.7±8.4岁）。8例患者右冠状动脉受累，2例患者左冠状动脉受累，4例患者双侧冠状动脉受累。入院时，9例患者有Q波（64.2%），7例（50%）下壁导联出现Q波，2例（14.2%）前壁或侧壁导联出现Q波。
医院死亡率为21.4%（14例患者中有3例）。其中，2例患者无法脱离体外循环，1例患者在重症监护病房死于多器官功能衰竭。
由于累及冠状动脉的A型急性主动脉夹层死亡率较高，立即进行冠状动脉旁路移植术和主动脉修复对于这组具有挑战性的患者是一种安全可靠的方法。
