Type A aortic dissection after Coronary Artery Bypass Grafting

Abstract

Patient: Female, 65-year-old Final Diagnosis: Aortic dissection Symptoms: Thoracic pain Clinical Procedure: — Specialty: Cardiac Surgery Objective: Rare disease Background: Aortic dissection is rare after coronary artery bypass grafting (CABG), but it is a potentially fatal complication of cardiac surgery. Reoperation may pose problems with thoracotomy, adhesiolysis, and myocardial protection. No standard treatment guidelines exist for chronic aortic dissection after CABG. We present a case of chronic type A aortic dissection after cardiac surgery, which was successfully treated. Case Report: A 65-year-old female patient presented with a medical background of hypertension, type 2 diabetes mellitus, and hyperlipidemia. No connective tissue disorders were diagnosed. The aortic valve was tricuspid. Three years ago, she underwent coronary artery bypass grafting involving 4 branches at a different medical facility. She reported chest pain weeks after bypass surgery, which gradually increased. Aortic dissection was observed in the latest contrast-enhanced CT scan, beginning from just above the sinotubular junction and reaching below the brachiocephalic trunk. Two grafts from the saphenous vein were patent, and 1 was lying just below the sternum. Cardiopulmonary support was initiated by cannulating the right femoral artery and vein. An opening in the ascending aorta exposed an intimal tear near the proximal anastomosis of the 2 great saphenous vein grafts. Antegrade del Nido cardioplegia was given through native ostia and functional bypass grafts. Proximal and then distal anastomosis of the graft prosthesis was performed. A new venous graft was anastomosed to the apical part of the left anterior descending artery (LAD). This saphenous vein and the buttons of the 2 previous vein grafts were anastomosed to the prosthesis. The patient was successfully liberated from the heart-lung machine and exhibited favorable cardiac function in the postoperative period. Conclusions: Initial peripheral cannulation with a half dose of heparin provides a relatively bloodless and secure re-entry sternotomy. del Nido cardioplegia is easy to implement, is safe, and gives surgeons enough time without interruptions to perform complex procedures.