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.
