Iatrogenic acute aortic dissection induced by off-pump coronary artery bypass grifting

Abstract

Rationale:Iatrogenic acute aortic dissection (IAAD) induced by cardiac surgery is a fatal complication, with 0.04% of therapeutic procedures and worse outcomes than spontaneous aortic dissection.Patients concerns:A 64-year-old male complaining of intermittent chest tightness for 4 years received an off-pump coronary artery bypass grifting (OPCABG) and IAAD was found during surgery.Diagnosis:Unstable angina, coronary artery triple vessel lesion, IAAD.Interventions:An ascending aorta replacement surgery was implemented immediately and extracorporeal membrane oxygenation (ECMO) was applied during surgery. The patient suffered from oliguria symptoms and began to receive continuous renal replacement therapy (CRRT) after surgery. What was worse, osteofascial compartment syndrome (OCS) was also confirmed the day after surgery.Outcomes:The CRRT and ECMO were both removed and the condition of the right leg was also stable. But the patient passed away because of uncontrollable sepsis 18 days after the surgery.Lessons:OPCABG is clearly the riskiest type of surgery associated with IAADs in cardiac surgical procedures, which should be considered with great concern. Whether ECMO should be used postoperatively in IAAD patients is still a controversial subject, due to some fatal complications linked with it.

Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures

“…Table 1 presents the descriptive analysis of these cases. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The 27 patients were aged 50 to 81 years, 25 (93%) males and 2 (7%) females. Among the patients, 23 (85%) were Europeans and 4 (15%) were Asians.…”

“…[ 28 ] However, for higher-risk patients, it may be that alternative methods should be performed without side-clamping of the aorta or on-pump CABG should be performed to prevent this redoubtable complication. [ 5 ] A detailed preoperative discussion within a multidisciplinary team should be conducted to choose the most suitable surgical technique for high-risk patients. Routine use of TEE for cardiac surgery reduces the mortality rate of IAD from 75% to 17%.…”

Iatrogenic Acute Type A Aortic Dissection following Elective Cardiopulmonary Bypass

“… 4 Thus, in our case, aortic arch repair could have been performed once aortic dissection was recognized. 5 6 …”

“…4 Thus, in our case, aortic arch repair could have been performed once aortic dissection was recognized. 5,6 Keywords ► cardiopulmonary bypass ► iatrogenic acute aortic dissection ► lower limb ischemia…”

Immediate Recognition and Surgical Treatment of Iatrogenic Acute Type A Aortic Dissection Is Associated with Low Hospital Mortality and High Intermediate-Term Survival

“…Iatrogenic ATAD (iATAD) is a relatively rare but life-threatening complication associated with cardiac surgery. It usually occurs during all types of cardiac surgery (hereinafter as the “intraoperative iATAD”), with the frequencies of occurrence of 0.06–0.23% [ 2 , 3 ]. Intraoperative iATAD is associated with a high mortality, which is reported to reach 48% [ 4 ].…”