Complication Of Cardiac Procedures Research Articles

Iatrogenic Type A Dissection: Case Series and Surgical Management From a High-Volume Aortic Center

BackgroundIatrogenic type A aortic dissection is a rare complication of surgical and nonsurgical cardiac procedures associated with high morbidity. The purpose of this study was to describe the intraoperative incidence, surgical management, and outcomes of iatrogenic type A dissections at our institution. MethodsRetrospective review of our institution’s adult cardiac surgery database was performed between 2002 and 2018 to identify all iatrogenic type A aortic dissection repairs. Operative reports were reviewed for cause of dissection and repair strategy. Follow-up surveillance for mortality and need for aortic reintervention was queried as available. ResultsOverall, 36 patients undergoing iatrogenic type A repairs were identified (cardiac surgical incidence, 0.1%). Of these, 23 (63.9%) were related to open operation, 5 (13.9%) to percutaneous coronary interventions, 5 (13.9%) to thoracic endovascular repairs, and 3 (8.3%) to other endovascular procedures. Most patients underwent hemiarch repairs under circulatory arrest (28/36 [77.8%]), whereas total arch repair was required in 5 of 36 (13.9%). Among all patients, in-hospital mortality was 36.1% (13/36). Those who survived to discharge had low subsequent mortality, with no differences between endovascular and surgical causes (P = .797). On median follow-up of 3.1 years, need for redo aortic surgery was limited to 4 (11.1%) patients, all successfully treated with endovascular therapy. ConclusionsIatrogenic type A dissections represent a rare but serious complication of cardiac procedures, with high in-hospital mortality for those undergoing surgical repair. A repair strategy involving an open distal anastomosis and proximal root reconstruction ensures durable freedom from need for redo surgery.

Iatrogenic type A aortic dissection: an uncommon but dangerous complication of cardiac procedures

Iatrogenic type A aortic dissection: an uncommon but dangerous complication of cardiac procedures

Introduction: cerebrovascular complications of cardiac procedures

Introduction: cerebrovascular complications of cardiac procedures

Renal Function in Children Undergoing Cardiac Operations

Because we sometimes observed large amounts of uric acid crystals in the urine of infants and children after open-heart operations and since renal insufficiency from any cause can be a serious complication of cardiac procedures, 8 acyanotic and 5 cyanotic children were studied prospectively by comparing several preoperative and postoperative measures of renal function. There were no significant differences between the acyanotic and cyanotic groups in terms of age, time on cardiopulmonary bypass, or other preoperative variables. Postoperatively, children in both groups had a wide range of free water clearances (C H 2O ), with some values in the range reported to be diagnostic of renal insufficiency in adults. Since none of these children had renal insufficiency by other criteria, C H 2O may not be as reliable an indicator of renal insufficiency in children. The major difference between the cyanotic and acyanotic groups was seen in postoperative serum uric acid levels (S UA); the mean S UA levels in the acyanotic and cyanotic groups were 5.3 ± 0.5 mg/dl (± standard error of the mean) and 10.4 ± 1.7 mg/dl (range, 8.0 to 15.5 mg/dl), respectively. Since the hyperuricemia in the cyanotic children could not be related to increased exogenous administration or decreased renal excretion, it is probably caused by increased endogenous production and may be related to the resolution of the cyanotic state.