Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion?
Objectives: Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusio...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S101595842300787X |
| _version_ | 1827591661826342912 |
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| author | Naoshi Minamidate Hodaka Wakisaka Kohei Hachiro Fumihiro Miyashita Masanori Morimoto Yasuo Kondo Masahide Enomoto Noriyuki Takashima Tomoaki Suzuki |
| author_facet | Naoshi Minamidate Hodaka Wakisaka Kohei Hachiro Fumihiro Miyashita Masanori Morimoto Yasuo Kondo Masahide Enomoto Noriyuki Takashima Tomoaki Suzuki |
| author_sort | Naoshi Minamidate |
| collection | DOAJ |
| description | Objectives: Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of “central repair and coronary artery bypass grafting” for patients with coronary and other organ malperfusion is unknown. Methods: Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared. Results: There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62). Conclusions: Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion. |
| first_indexed | 2024-03-09T01:35:52Z |
| format | Article |
| id | doaj.art-138e26d878294f66809e01afcefbe701 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-03-09T01:35:52Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-138e26d878294f66809e01afcefbe7012023-12-09T06:04:25ZengElsevierAsian Journal of Surgery1015-95842023-12-01461254495453Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion?Naoshi Minamidate0Hodaka Wakisaka1Kohei Hachiro2Fumihiro Miyashita3Masanori Morimoto4Yasuo Kondo5Masahide Enomoto6Noriyuki Takashima7Tomoaki Suzuki8Corresponding author. Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.; Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanDepartment of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, JapanObjectives: Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of “central repair and coronary artery bypass grafting” for patients with coronary and other organ malperfusion is unknown. Methods: Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared. Results: There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62). Conclusions: Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion.http://www.sciencedirect.com/science/article/pii/S101595842300787XMalperfusionCoronary malperfusionAcute type A aortic dissectionCoronary artery bypass grafting |
| spellingShingle | Naoshi Minamidate Hodaka Wakisaka Kohei Hachiro Fumihiro Miyashita Masanori Morimoto Yasuo Kondo Masahide Enomoto Noriyuki Takashima Tomoaki Suzuki Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? Asian Journal of Surgery Malperfusion Coronary malperfusion Acute type A aortic dissection Coronary artery bypass grafting |
| title | Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? |
| title_full | Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? |
| title_fullStr | Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? |
| title_full_unstemmed | Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? |
| title_short | Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? |
| title_sort | is central repair with coronary artery bypass grafting enough for multi organ malperfusion in acute type a aortic dissection with coronary malperfusion |
| topic | Malperfusion Coronary malperfusion Acute type A aortic dissection Coronary artery bypass grafting |
| url | http://www.sciencedirect.com/science/article/pii/S101595842300787X |
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