Perioperative Aortic Dissection: Early Recognition Improves Outcome

Abstract

Perioperative (intra- and early postoperative) aortic dissection in cardiac surgery is a rare but potentially lethal complication. Immediate recognition and appropriate treatment are needed. We reviewed the incidence of perioperative dissection in a consecutive series of 9118 patients operated on during a 6-year period. There were 9 cases of proximal aortic dissection, one dissection was diagnosed at autopsy only. There were 8 males and 1 female (mean age 64 years, range 46–75). The initial procedure was CABG in 6, CABG with mitral valve repair in 2 and redo aortic valve replacement in 1. All patients had cardiovascular risk factors, arterial hypertension being present in 8 and multifocal atherosclerosis in 6. Five patients had undgrgone a previous arterial reconstruction. In 6 patients, aortic dissection was identified before sternotomy closure during the initial procedure, in one patient during hospitalization, in one 18 days after discharge. Aortic repair was performed in 8 cases and consisted of supracoronary ascending aortic graft in 6, proximal descending repair in one and composite graft replacement in one patient. Two patients died early postoperatively due to low cardiac output. One patient developed paraplegia, although aortic repair had been performed without technical difficulty. There were no deaths directly related to the dissection in those patients where it had been immediately recognized during the initial operation. Iatrogenic aortic dissection complicating open heart surgery with the aid of extracorporeal circulation is encountered with an incidence of approximately 0.01%. The prognosis is improved if it is recognized immediately. Graft repair is the treatment of choice.