A Clinical Study Based On The Classification Of Acute Type A Aortic Dissection Involving The Extra-fusal Coronary Artery

Although myocardial ischemia or myocardial infarction caused by acute Type A aortic dissection with coronary artery involvement is relatively rare,when it happens,for patients,it is a fatal disaster,and for cardiac surgeons,it is a difficult and challenging problem.This paper,combined with the relevant literatures and the clinical research of Vascular Surgery Center of Fuwai Hospital,mainly reviews the pathological classification,pathogenesis,clinical treatment and other aspects of coronary artery involvement.Objective To study the surgical treatment strategy of Acute Type A Aortic Dissection Involving Coronary Artery on the basis of Fuwai type and evaluate the clinical efficacy.Methods 50 patients with coronary involvement were retrospectively analyzed from Apr.2014 to Aug.2016.The treatment mothods is based on Fuwai Type,mainly including Coronary Artery Repair(CAR)and Coronary Artery Bypass Grafting(CABG).The clinical effect of this surgical strategy in the perioperative and follow-up period is analysed.Results A total of 50 patients were included.Of which,38 patients were treated with CAR,12 patients CABG,including 3 remedial bypass and 2 prophylactic bypass.All patients were followed up from 4 to 32 months,with an average time of 18.6 months.In group CABG,1 patients died of multiple organ failure after surgery,and the other patients had no major adverse cardiovascular events and deaths during perioperative period and follow-up period.Conclusion This strategy for the treatment of involved coronary arteries based on the Fuwai Type has some guiding significance on the surgical treatment of acute Type A aortic dissection.