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目的 探究急性A型主动脉夹层伴冠状动脉受累的临床特征和手术治疗效果。方法 纳入确诊为急性A型主动脉夹层并行手术治疗的103例患者。其中无冠状动脉受累72例（常规组），伴有冠状动脉受累31例（ACI组）。通过对病例资料的回顾性分析，对比两组之间的临床特征和手术治疗效果。结果 与常规组相比，ACI组的中度及以上程度主动脉关闭不全占比及心肌缺血表现比例明显升高、左室射血分数略有降低，差异均有统计学意义（P<0.05）；ACI组中行Bentall手术患者占比明显增加。常规组院内死亡9例（12.5%），ACI组院内死亡6例（19.4%）。全组共行冠状动脉旁路移植术16例，其中常规组合并冠心病1例，ACI组行大隐静脉右冠状动脉旁路移植术15例。多因素Logistic回归显示术前肌钙蛋白升高和术后血液透析是院内死亡的独立危险因素。结论 合并冠状动脉受累的急性A型主动脉夹层患者院内病死率明显升高，常需同期行CABG，术前肌钙蛋白升高及术后血液透析为独立死亡危险因素。
Abstract：Objective To investigate the clinical characteristics and surgical outcomes of acute type A aortic dissection with concomitant coronary artery involvement. Methods A total of 103 patients diagnosed with acute type A aortic dissection who underwent surgical repair were enrolled. The cohort was divided into two groups: 72 patients without coronary involvement (conventional group) and 31 patients with coronary involvement (ACI group). Clinical features and surgical outcomes were compared between the two groups through retrospective chart review. Results Compared with the conventional group， the ACI group showed a significantly higher proportion of moderate or severe aortic regurgitation and a greater frequency of myocardial ischemic manifestations， along with a modest reduction in left ventricular ejection fraction (all P<0.05). The Bentall procedure was performed more frequently in the ACI group. In-hospital mortality was 12.5% (9/72) in the conventional group versus 19.4% (6/31) in the ACI group. Coronary artery bypass grafting was performed in 16 patients across the entire cohort: one patient in the conventional group had concomitant coronary artery disease， while 15 patients in the ACI group underwent saphenous vein grafting to the right coronary artery. Multivariate logistic regression identified elevated preoperative troponin and postoperative hemodialysis as independent risk factors for in-hospital death. Conclusion Patients with acute type A aortic dissection complicated by coronary artery involvement have a notably higher in-hospital mortality and frequently require concomitant CABG. Elevated preoperative troponin and postoperative hemodialysis serve as independent predictors of mortality.
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基本信息:
中图分类号:R654.2
引用信息:
[1]杨健康,陈焘,许金国,等.急性A型主动脉夹层伴冠状动脉受累的早期手术疗效对比[J].安徽医科大学学报().
基金信息:
安徽省高等学校省级质量工程项目（编号：2024jyxm0710）
2026-08-27
2026-08-27
2026-08-27