Spontaneous coronary artery dissection surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Coronary artery bypass graft (CABG) is an important reperfusion therapy in a selected group of SCAD patients and also a rescue strategy in the management of failed PCI.Indications for surgical revascularization include multivessel involvement, Left main coronary artery involvement, progression/worsening of dissection , significant narrowing of the arterial lumen, refractory or recurrent myocardial ischemia. In the event of severe refractory heart failure, heart transplantation may be considered.

• Emergent CABG should be considered for patients with left main dissections, extensive dissections involving proximal arteries, or in patients in whom PCI failed or who are not anatomically suitable for PCI.
• Good early outcomes following CABG have been reported in small observational studies.^{[1] [2] [3]}
• Early graft failure was reported as 6% in a 20 patients series. ^{[2] [3]}
• long term results of CABG showed lower graft patency (27%) because of spontaneous arterial healing which lead to competitive flow and graft thrombosis. ^[4]

• Indications for surgical revascularization include: (CABG)^[5] include:
• Multivessel involvement
• Left main coronary artery involvement
• Progression/worsening of dissection so long as there is a distal target
• Significant narrowing of the arterial lumen
• Refractory or recurrent myocardial ischemia

• • In the event of severe refractory heart failure, heart transplantation may be considered.