Guenther Sabina P W, Peterss Sven, Reichelt Angela, Born Frank, Fischer Matthias, Pichlmaier Maximilian, Hagl Christian, Khaladj Nawid
Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.
Department of Clinical Radiology, University Hospital Munich, Ludwig-Maximilian University, Munich, Germany.
Heart Surg Forum. 2014 Oct 1;17(5):E253-7. doi: 10.1532/HSF98.2014397.
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.
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.
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.
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.
斯坦福A型急性主动脉夹层（AADA）患者因合并冠状动脉疾病（CAD）或冠状动脉夹层导致的心肌缺血与心肌衰竭及不良预后相关。该组患者术前冠状动脉造影仍存在争议。使用CT扫描诊断冠状动脉病变并建立高分辨率双螺旋CT方案对于改善预后至关重要。
我们回顾性分析了6例使用体外生命支持（ECLS）治疗的AADA心力衰竭患者。讨论了该患者队列中诊断冠状动脉病变的方法以及心脏术后心源性休克的不同治疗策略。
对CT图像的回顾性分析显示，83%（n = 5）的患者存在冠状动脉异常。4例患者（67%）接受了非计划性冠状动脉旁路移植术（CABG）。67%（n = 4）的患者因左心衰竭接受了ECLS，33%（n = 2）的患者因右心衰竭接受了ECLS。30天死亡率为67%（n = 4）。接受ECLS支持右心室的2例患者存活，且均接受了CABG。
除了术前评估夹层范围外，关注CT扫描中的冠状动脉病变有助于对手术进行分类。混合手术室允许立即进行介入和/或手术治疗，并能立即控制血运重建结果。在某些情况下，使用ECLS而非其他类型的心室支持系统可能有助于心肌恢复。
