Document Detail


Iatrogenic type A aortic dissection during cardiac surgery.
MedLine Citation:
PMID:  20299447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We reviewed our experience of intraoperative type A aortic dissection during cardiovascular surgery. From January 1998 to May 2009, intraoperative aortic dissection occurred in 10 of 3421 cardiac surgical patients (M:F=4:6, 62.4+/-8.0 years). Preoperative diagnoses were valvular heart disease (n=6), ischemic heart disease (n=2), combined disease (n=1) and aortic aneurysm (n=1). All underwent total circulatory arrest (TCA) with retrograde cerebral perfusion and the torn aorta was replaced (n=8) or repaired (n=2). Iatrogenic type A dissection occurred in 0.29% of patients. It was related with cannulation of ascending aorta (n=4), axillary artery (n=2), aortic root (n=2), and femoral artery (n=1) and aortotomy repair (n=1). Mortality rate was 40% (4/10). After adoption of routine intraoperative transesophageal echocardiography, mortality rate decreased from 75% (3/4) to 17% (1/6) (P=0.190). We initiated TCA before achieving deep hypothermia in three of four non-survivors. There was a trend of increased mortality when the disease extended beyond aortic arch (67%, 4/6 vs. 0%, 0/4; P=0.076). Although intraoperative aortic dissection occurred in <0.3% of our patient population, mortality was high, especially when it extended beyond the arch vessels. Better results were expected when early recognition and proper treatment under deep hypothermic circulatory arrest could be performed.
Authors:
Ho Young Hwang; Dong Seop Jeong; Kyung-Hwan Kim; Ki-Bong Kim; Hyuk Ahn
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Publication Detail:
Type:  Journal Article     Date:  2010-03-18
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-08-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  896-9     Citation Subset:  IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Dissecting / etiology*,  mortality,  surgery,  ultrasonography
Aortic Aneurysm / etiology*,  mortality,  surgery,  ultrasonography
Blood Vessel Prosthesis Implantation
Cardiac Surgical Procedures / adverse effects*,  mortality
Cardiopulmonary Bypass
Circulatory Arrest, Deep Hypothermia Induced
Echocardiography, Transesophageal
Female
Humans
Iatrogenic Disease*
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Suture Techniques
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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