Acute Type A Aortic Dissection Associated with Acute Coronary Involvement --- with or without Coronary Malperfusion

Acute type A aortic dissection (TAAAD) is potentially fatal. Emergency or urgent surgery is generally believed to be able to save and extend the patient’s life, and delayed surgery or overtly conservative medical treatment can result in a high probability of sudden death. Approximately one-third of all patients with TAAAD have preoperative end-organ malperfusion syndromes that might cause myocardial, cerebral, spinal, mesenteric, renal, and limb ischemia. Acute coronary involvement (ACI) has an approximate incidence of 6-19% in patients with TAAAD. TAAAD with sinus of Valsalva involvement and coronary malperfusion generally requires aortic root replacement and coronary artery bypass grafting; it is also associated with significant surgical mortality. The therapeutic goal for patients with ACI is the rapid restoration of myocardial perfusion and correction of the damaged aortic root structure in order to alleviate the malperfusion syndrome. Techniques selected for treating these patients should be considered based on the causal mechanism. Endovascular strategies are emerging that may lead to less-invasive treatment options for patients who are considered poor candidates for direct surgical repair because they have TAAAD, which involves the ascending aorta. Nevertheless, it is questionable whether these treatment options can be used on patients with ACI. TAAAD patients with ACI have an increased risk of postoperative in-hospital mortality and less-favorable long-term survival. Regular medical follow-up, careful periodic imaging surveillance of the aorta, and lifestyle modification are mandatory for patients after repairs for ACI.

Keywords: Acute aortic dissection, Acute aortic syndrome, Acute coronary involvement, Acute coronary syndrome, Acute myocardial infarction, Annulo-aortic ectasia, Aortic root replacement, Aortic valve regurgitation, Bentall procedure, Cardiopulmonary bypass, Commissural dehiscence , Composite valve prosthesis, Connective tissue disorder, Coronary artery bypass grafting, Coronary malperfusion, Coronary ostia, Marfan syndrome, Myoischemia, Ostia damage, Sinus of Valsalva, Valve-sparing root replacement.