OBJECTIVE: Iatrogenic aortic dissection (IAD) is a rare complication of cardiac procedures. We herein describe our management and results of this complication. METHODS: A total of 55 279 patients underwent open heart surgery at our centre from 1995 to 2010, and 135 262 patients underwent cardiac catheterization over the same time period. We identified 48 patients from this cohort who underwent emergency surgery for IAD that occurred either during or shortly after cardiac surgery, or following cardiac catheterization. RESULTS: The incidence of IAD was 0.06% (n = 36) for cardiac surgical procedures and 0.01% (n = 12) for cardiac catheterization procedures. The mean patient age was 66 ± 14 years and 50% were female. Intraoperative IAD occurred during aortic cannulation in 12 patients, insertion of the cardioplegia cannula in 7 patients, manipulation of the aortic crossclamp in 4 patients or during other events in 8 patients. IAD occurred early postcardiac surgery in 5 patients, and during cardiac catheterization in the remaining 12 patients. IAD was treated by emergent replacement of the ascending aorta and the aortic arch (when involved), as well as aortic root replacement or repair as indicated. Early mortality was 41.7: 35.5% for intraoperative IAD, 60.0% for postoperative IAD and 50.0% for cardiac catheterization-associated IAD (P = 0.5). Histological investigation revealed atherosclerosis in 61.2% of patients, cystic medial necrosis in 22.2%, aortitis in 2.8% and other pathologies in 13.8%. Follow-up was 100% complete with a 5-year survival of 40 ± 0.4%. CONCLUSION: IAD is a rare but dangerous complication of cardiac surgery and cardiac catheterization, and is frequently associated with pre-existing aortic pathology.
OBJECTIVE: Iatrogenic aortic dissection (IAD) is a rare complication of cardiac procedures. We herein describe our management and results of this complication. METHODS: A total of 55 279 patients underwent open heart surgery at our centre from 1995 to 2010, and 135 262 patients underwent cardiac catheterization over the same time period. We identified 48 patients from this cohort who underwent emergency surgery for IAD that occurred either during or shortly after cardiac surgery, or following cardiac catheterization. RESULTS: The incidence of IAD was 0.06% (n = 36) for cardiac surgical procedures and 0.01% (n = 12) for cardiac catheterization procedures. The mean patient age was 66 ± 14 years and 50% were female. Intraoperative IAD occurred during aortic cannulation in 12 patients, insertion of the cardioplegia cannula in 7 patients, manipulation of the aortic crossclamp in 4 patients or during other events in 8 patients. IAD occurred early postcardiac surgery in 5 patients, and during cardiac catheterization in the remaining 12 patients. IAD was treated by emergent replacement of the ascending aorta and the aortic arch (when involved), as well as aortic root replacement or repair as indicated. Early mortality was 41.7: 35.5% for intraoperative IAD, 60.0% for postoperative IAD and 50.0% for cardiac catheterization-associated IAD (P = 0.5). Histological investigation revealed atherosclerosis in 61.2% of patients, cystic medial necrosis in 22.2%, aortitis in 2.8% and other pathologies in 13.8%. Follow-up was 100% complete with a 5-year survival of 40 ± 0.4%. CONCLUSION:IAD is a rare but dangerous complication of cardiac surgery and cardiac catheterization, and is frequently associated with pre-existing aortic pathology.
Authors: Evren Özçınar; Mehmet Çakıcı; Çağdaş Baran; Fatih Gümüş; Alper Özgür; Levent Yazıcıoğlu; Bülent Kaya; Ahmet Rüçhan Akar Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2018-01-09 Impact factor: 0.332