Intraoperative aortic dissection

Abstract

Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication.

Intraoperative Aortic Dissection ­Complicating Elective Off-pump Coronary Artery Bypass Surgery

“…Acute type A aortic dissection is a rare but extremely dramatic complication of elective cardiac surgery with a frequency of 0.04 to 1%. (1)(2)(3)(4) In our series, the incidence of this complication was 0.28%. According to the literature, intraoperative dissections are observed more often, (6,8) although there are data on the dissections in early and late postoperative period (4) .…”

“…(8) Postoperative mortality ranges from 15% to 50%. (2,3,8) In our series mortality rate achieved 100%, one patient died intraoperatively due to acute aortic rupture, second patient died due to acute respiratory distress on 10 th postoperative day.…”

Iatrogenic Aortic Pseudoaneurysm After an Aortic Valve Replacement Requiring Emergency Reoperation

“…The incidence of intraoperative aortic dissection during cardiac surgery has been reported to be around 0.12% to 0.35%, but as high as 0.6% after an aortic valve replacement. 2 The most common sites of aortic injury include ascending aortic cannulation site, cross-clamp site, the site of the partialocclusion clamp, the proximal anastomosis site, antegrade cardioplegia cannulation site, and axillary artery cannulation site. 2 Additionally, older age, hypertension, aortic trauma, aortic instrumentation, severe atherosclerotic disease of the aorta, family history of aortic aneurysm/dissection, arteritis, a thin or dilated ascending aorta, or collagen vascular diseases are among numerous risk factors predisposing patients to intraoperative aortic injury.…”

“…2 The most common sites of aortic injury include ascending aortic cannulation site, cross-clamp site, the site of the partialocclusion clamp, the proximal anastomosis site, antegrade cardioplegia cannulation site, and axillary artery cannulation site. 2 Additionally, older age, hypertension, aortic trauma, aortic instrumentation, severe atherosclerotic disease of the aorta, family history of aortic aneurysm/dissection, arteritis, a thin or dilated ascending aorta, or collagen vascular diseases are among numerous risk factors predisposing patients to intraoperative aortic injury. The patient in this case was at a higher risk of aortic injury, given her age, hypertension, thinwalled mildly dilated ascending aorta, and the type of surgery in which aortic instrumentation was mandatory for cannula and cross-clamp placement.…”

Iatrogenic dissection of the descending aorta: Conservative or endovascular treatment?

“…However, in the case of extended dissection, with hemodynamic instability and complications due to dissection, TEVAR should be the treatment of choice. [ 3 8 9 ] The classical, open surgical intervention is not recommended taken in mind that patients who underwent on TAVI are usually very old and have a very high operative risk.…”