Hemolytic anemia caused by kinked graft 6 months after aortic dissection repair

Abstract

Background Clinically insignificant hemolytic anemia is occasionally a complication of prosthetic valve replacement. However, hemolysis related to kinked grafts is a very rare complication after central repair for acute aortic dissection. Case presentation A 42-year-old man had undergone replacement of the ascending aorta and a root repair for type A aortic dissection 6 months previously. Laboratory data showed mild hemolysis 5 months later, and he began to complain of fatigue on exertion. The serum hemoglobin level reduced to 8.6 g/dL, and lactate dehydrogenase levels increased to 3071 IU/L with gross change in urine color, indicating hemoglobinuria. We diagnosed mechanical hemolytic anemia caused by a kinked graft and planned a repeat operation. The kinked graft was resected and graft-graft anastomosis was performed. Postoperatively, the clinical course was uneventful, and the hemolytic anemia completely resolved. Conclusion We herein report a case of hemolytic anemia caused by kinking of the graft 6 months after acute aortic dissection repair. The diagnosis was swiftly made, and the patient was successfully managed with redo surgery.

Hemolytic Anemia Caused by Graft Kinking Following Ascending Aortic Replacement: Endovascular Treatment With a Palmaz XL Stent

“…Although four-dimensional magnetic resonance imaging also could not show the blood flow at the stenotic site, it showed turbulent flow and increased flow velocity at the site distal to stenosis, which helped confirm that the stenosis was the cause of hemolytic anemia. Although open surgery has been a treatment choice in most previous reports, [1][2][3][4] it is not always feasible because of difficulties in accessing the kinked graft, as in our case. 4 An Excluder cuff was initially used in our case; however, the expanding force might have been insufficient to avoid migration caused by the brisk flow of the ascending aorta.…”

“…High shear stress, turbulent flow, and physical contact are the main causes of mechanical damage to red blood cells. [1][2][3] Graft kinks following aortic replacement can lead to luminal stenosis and hemolytic anemia. Reportedly, there were only 30 cases in which hemolytic anemia developed after aortic surgery in the English literature until 2018.…”