Tang Paul C, Akhter Shahab A, Osaki Satoru, Lozonschi Lucian, Kohmoto Takushi, De Oliveira Nilto C
Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Aorta (Stamford). 2017 Jun 1;5(3):71-79. doi: 10.12945/j.aorta.2017.16.058. eCollection 2017 Jun.
Preoperative coronary angiography is often not performed in acute Type A dissection. We examined differences in the incidence of pre-existing coronary disease and subsequent coronary events between patients undergoing acute Type A dissection repair and patients undergoing elective proximal aortic aneurysm repair.
From 2000 to 2015, there were 154 acute Type A dissection repairs and 457 elective proximal aortic aneurysm repairs. We performed a retrospective review to evaluate preoperative coronary disease and postoperative coronary interventions such as percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG).
A total of 31 (20%) dissection patients and 123 (27%) elective surgery patients had preoperative evidence of coronary artery disease (p = 0.094). All elective surgery patients but only six (4%) dissection patients had preoperative coronary catheterization. More CABGs were performed in the elective surgery group (19%) than in the dissection group (3%, p < 0.001). There were no differences in the incidence of prior PCI, CABG, or myocardial infarction between groups. Following dissection repair, four patients required coronary interventions. Of these, two (1.3%) experienced chest pain and underwent PCI at 4.7 and 4.3 months postoperatively, respectively, and another two experienced symptoms and required PCI at 5 and 7 years, respectively. The 30-day and 14-year mortality rates after dissection repair were 13% and 24%, respectively. Although the dissection group had poorer survival than the elective surgery group (p < 0.001), there was no difference in conditional survival after aortic-related deaths over the first year were censored (p = 0.104).
Given the low incidence of missed significant coronary disease (1.3%), it is reasonable to perform Type A dissection repair without coronary angiography.
急性A型主动脉夹层患者通常不进行术前冠状动脉造影。我们研究了接受急性A型主动脉夹层修复的患者与接受择期近端主动脉瘤修复的患者之间，既往存在冠心病的发生率以及随后发生冠状动脉事件的差异。
2000年至2015年期间，有154例急性A型主动脉夹层修复手术和457例择期近端主动脉瘤修复手术。我们进行了一项回顾性研究，以评估术前冠心病情况以及术后冠状动脉干预措施，如经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）。
共有31例（20%）夹层患者和123例（27%）择期手术患者有术前冠状动脉疾病的证据（p = 0.094）。所有择期手术患者均进行了术前冠状动脉导管检查，但只有6例（4%）夹层患者进行了该项检查。择期手术组进行CABG的比例（19%）高于夹层组（3%，p < 0.001）。两组之间既往PCI、CABG或心肌梗死的发生率没有差异。夹层修复术后，有4例患者需要进行冠状动脉干预。其中，2例（1.3%）分别在术后4.7个月和4.3个月出现胸痛并接受了PCI，另外2例分别在术后5年和7年出现症状并需要进行PCI。夹层修复术后30天和14年的死亡率分别为13%和24%。尽管夹层组的生存率低于择期手术组（p < 0.001），但在剔除第一年因主动脉相关死亡后的条件生存率方面没有差异（p = 0.104）。
鉴于漏诊严重冠心病的发生率较低（1.3%），在不进行冠状动脉造影的情况下进行A型主动脉夹层修复是合理的。
