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DOI: 10.1055/s-0030-1269331
Aortic dissections after previous cardiac surgery
Objectives: The danger of aortic dissection following cardiac surgery is recognized. Information on incidence, etiology and outcome is sparse but increasing experience defines a more distinct clinical management.
Methods: Data of aortic dissections that occurred intra- or postoperatively after previous cardiac surgery in four institutions were analysed retrospectively.
Results: A total of 42 cases (14F, 28M; mean 65.3 years) with type-A dissection following cardiac surgery (14xAVR, 18xCABG, 3xAVR+CABG, 3xDVR, 4xMVR) were identified (n total 24.298, prevalence 0.17%). Only one single case (4%) presented with signs of pericardial tamponade. Cases were treated with supracoronary tube graft (23) + hemiarch (7) or conduit (12). Intraoperative dissections (n=14) had a 30d-mortality of 28% (4/14). Other AD (n=15, mean interval 2.7y) required concomitant CABG in 7 cases and had a 30d-mortality of 46% (7/15) due to MCI/LCO in all cases. In 13 chronic dissections, surgical treatment was elective after a mean interval of 4.0 years. Mortality was 38% (5/13) also due to MCI/LCO. The aorta was initially described or proven histologically as pathologic and the entry tear was found at sites of previous surgical manipulation in nearly all cases.
Conclusions: Aortic type-A dissections can follow preceeding cardiac operations at any time without „typical“ interval. Overall hospital mortality (38%) is typically due to myocardial infarction. Coronary status was initially unknown in all non-survivors. The dissection tear entry in the majority of cases refers to sites of previous surgical manipulation and the event is triggered by pathological vessel wall histology and hypertension in most cases.