Use of coronary arteriography in the preoperative management of patients undergoing urgent repair of the thoracic aorta

Kern, Morton J.; Serota, Harvey; Callicoat, Paul; Deligönül, Ubeydullah; Lee, Woo-Hyeong; Aguirre, Frank V.; Lew, Brian; Barner, Hendrick B.; Willman, Vallee L.

doi:10.1016/s0002-8703(05)80094-8

Cited by 45 publications

(14 citation statements)

References 22 publications

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“…Not surprisingly, the concomitant presence of coronary artery disease at the time of diagnosis of aortic dissection is Ϸ25%. 69 It is unclear whether there is any perioperative or postoperative benefit to doing preoperative coronary angiography for all stable patients. 70 Mortality after surgery for aortic dissection seems unrelated to myocardial ischemia; therefore, we cannot conclude that revascularization intraoperatively would change postoperative outcomes.…”

Section: Aortographymentioning

confidence: 99%

Acute Aortic Syndromes

2005

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Section: Aortographymentioning

confidence: 99%

Acute Aortic Syndromes

2005

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“…In stable patients, particularly those with aortic type B (type III) dissection, coronary angiography can be performed safely and represents a part of the staging in the chronic phase of the disease [144,145] .…”

Section: Signs Of Myocardial Ischaemiamentioning

confidence: 99%

“…Although new imaging techniques are gaining an emerging role in the assessment of coronary ostial involvement by the dissecting flap, coronary angiography remains the gold standard in the evaluation of the whole coronary tree [144,145] . This is important because chronic coronary atherosclerotic disease (present in 25% of patients) -although not related to the process of aortic dissection -may worsen the surgical outcome.…”

Section: Coronary Angiographymentioning

confidence: 99%

Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology

Erbel

Alfonso²,

Boileau³

et al. 2001

European Heart Journal

1,078

336

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“…Indeed, a history of coronary artery disease is associated with increased risk for in-hospital death following Type A dissection repair [11]. Kern et al found a potential survival benefit of preoperative coronary angiography in patients with Type A dissection with significant clinical history suggestive of coronary artery disease [12]. Interestingly, patients with prior open heart surgery presenting with acute Type A dissection infrequently have tamponade or hemodynamic collapse, which may be due to scar tissue providing support for mediastinal structures.…”

Section: Discussionmentioning

confidence: 99%

Coronary Events in Patients Presenting for Repair of Acute Type A Aortic Dissection

Tang¹,

Akhter²,

Osaki³

et al. 2017

aorta

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Background: 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. Methods: 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). Results: 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). Conclusions: Given the low incidence of missed significant coronary disease (1.3%), it is reasonable to perform Type A dissection repair without coronary angiography.

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Use of coronary arteriography in the preoperative management of patients undergoing urgent repair of the thoracic aorta

Cited by 45 publications

References 22 publications

Acute Aortic Syndromes

Acute Aortic Syndromes

Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology

Coronary Events in Patients Presenting for Repair of Acute Type A Aortic Dissection

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