Richard E. Clark Award. Aortic dissection as a complication of cardiac surgery: report from the Society of Thoracic Surgeons database.

BACKGROUND: Aortic dissection as a complication of cardiac surgery is a rare but often lethal event. We sought to determine the frequency of this complication in the STS (Society of Thoracic Surgeons) database as well as the outcomes of patients who suffer intraoperative aortic dissection. We then developed a model to identify preoperative characteristics and intraoperative factors associated with the complication.
METHODS: All patients from the STS database who underwent coronary artery bypass grafting, aortic valve surgery, or mitral valve surgery were included. Exclusion criteria included any patient who had aortic dissection listed as a reason for urgent or emergent operation. Data collected were then analyzed to describe the frequency of aortic dissection as a complication as well as its consequences. We then analyzed a more recent era that included information on arterial cannulation site (femoral-other versus aortic) to identify risk factors for aortic dissection.
RESULTS: Of 2,219,991 patients analyzed, 1,294 suffered aortic dissection as a complication of their surgery, for an incidence of 0.06%. This complication frequently led to catastrophic results, with 615 of 1,294 (48%) operative mortality. A logistic regression model was created based on 2004 to 2007 STS data. Of 680,025 patients analyzed, 436 patients suffered an aortic dissection. The analysis yielded nine significant risk factors including femoral arterial cannulation, preoperative steroids, and Asian race; the presence of diabetes appeared to be protective.
CONCLUSIONS: Aortic dissection is a rare but catastrophic complication of cardiac surgery. Femoral cannulation is associated with an increased frequency of this complication.