Iatrogenic Aortic Dissection Research Articles

Primary Aortic Coarctation Repair in Adolescents and Adults

ObjectiveOptimal management of primary aortic coarctation in adolescents and adults remains controversial. We assess early and late mortality of repair, longitudinal anti-hypertensive regimens, and freedom from reintervention for repair-related complications. MethodsFrom 01/01/1999–07/01/2023, 110 adolescents or adults, mean age 39±16 years, underwent primary aortic coarctation repair at Cleveland Clinic. Patients were grouped by repair strategy: stented (60, 55%), grafted (interposition graft or extra-anatomic bypass; 36, 33%), or other (14, 13%). Longitudinal anti-hypertensive regimens were assessed parametrically. Freedom from reintervention and survival were assessed by the Kaplan-Meier method. Median follow-up for survival was 9.2 years. ResultsOne patient (0.91%) died in-hospital. Major morbidity included stroke (2/107, 1.9%), tracheostomy (2/107, 1.9%), acute renal failure requiring dialysis (1/108, 0.93%), iatrogenic aortic dissection (1/107, 0.93%) and vascular access complication (1/56, 1.8%). Prevalence of patients requiring zero anti-hypertensive medications postoperatively peaked within two years. Twelve-year freedom from reintervention was 69% in the stented group and 97% in the grafted group (P log-rank = .003). Most reinterventions were for in-stent restenosis of bare metal stents. Overall freedom from reintervention at one, five, and 12 years was 91%, 80%, and 76%. Overall survival was 98%, 95%, and 80% at five, 10, and 14 years. ConclusionsA tailored approach to coarctation repair in adolescents and adults utilizing stented repair when anatomically feasible yields excellent short-term outcomes, but patients require persistent hypertension monitoring and have lower than expected long-term survival. Covered stents or stent grafts are preferred to bare metal stents which are subject to in-stent restenosis.

Management of iatrogenic ascending aortic dissection after percutaneous intervention of chronic total occlusion.

This study highlights the prevalence and conservative management strategies of iatrogenic ascending aortic dissection after percutaneous intervention (PCI) of chronic total occlusion (CTO). Retrospective analysis on patients who underwent CTO PCI from one medical center from 2020 to 2022 was performed by two operators. Data was obtained from the Prospective Global Registry for the Study of CTO database. Out of 318 patients, there were six reported cases of iatrogenic ascending aortic dissection. The causes of dissection included guiding catheter trauma, antegrade injection, two retrograde injection, and two cases of balloon rupture after lithotripsy. IVUS-guided stenting of the coronary back to the origin to seal the entry of the dissection flap occurred in two patients. All patients had a conservative management approach. No patient had to undergo urgent surgery. While the incidence remains rare, complications, including aortic dissection, are more frequent in CTO PCI as compared to non-CTO PCI. IVUS can be used to complete coronary intervention so long as the patient remains clinically and hemodynamically stable. Patients should have formal imaging with either transesophageal echocardiogram or computed tomography angiography. The outcomes of patients who experience iatrogenic aortic dissection during CTO PCI with stable coronary disease seem to be better than in patients with acute coronary syndrome.

Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures.

Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes. Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed. Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment). Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.

Watchful Waiting Strategy in Extensive Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention

Watchful Waiting Strategy in Extensive Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention

A Case Report: Iatrogenic Aortic Dissection During Minimally Invasive Mitral Valve Surgery: A Successful Management

A Case Report: Iatrogenic Aortic Dissection During Minimally Invasive Mitral Valve Surgery: A Successful Management

Iatrogenic aortic dissection during aortic root replacement in an older Loeys–Dietz syndrome type III patient with no family history of aortic disease: a case report

BackgroundIatrogenic aortic dissection during cardiac surgery is a rare but critical complication. At present, no strategies have been developed to prevent it. We herein report a case of intraoperative aortic dissection during aortic root replacement in an older patient with Loeys–Dietz syndrome type III who had no family history of aortic disease.Case presentationA 60-year-old man was admitted to the hospital for Stanford type B acute aortic dissection and given conservative treatment. He was found to have aortic root dilatation and severe aortic regurgitation. Thus, elective Bentall procedure was performed. Postoperative computed tomography showed new Stanford type A aortic dissection that may have developed due to aortic cannulation during surgery. The patient was given conservative treatment and successfully discharged to home at postoperative day 34. Although he had no family history of aortic disease, a genetic test revealed an unreported SMAD3 frameshift mutation (c.742_749dup, p. Gln252ThrfsTer7), and the patient was diagnosed with Loeys–Dietz syndrome type III.ConclusionIn patients with connective tissue disorder, aortic manipulations may become the cause of critical complications. Avoiding the use of invasive techniques, such as cannulation and cross-clamping, and implementing treatment strategies, such as perfusion from other sites than the aorta and open distal anastomosis, can prevent these complications, and may be useful treatment modalities. The possibility of connective tissue disease should be considered even if the patient is older and has no family history of aortic disease.

Endovascular management of iatrogenic aortic dissection using a minimally invasive method.

Endovascular management of iatrogenic aortic dissection using a minimally invasive method.

A late presentation of acute iatrogenic aortic dissection following percutaneous coronary intervention: A case report

Acute iatrogenic aortic dissection following percutaneous coronary intervention is a rare but sinister cause of post-procedure morbidity and mortality. Delayed diagnosis increases the mortality significantly. We present a case of a 52-year-old male who presented with an iatrogenic aortic dissection following percutaneous coronary intervention for an inferior ST-elevation myocardial infarction. Although the diagnosis was initially missed by conventional imaging for a period of 5 months, it was later diagnosed assisted by cardiac computed tomography. The patient underwent aortic repair with a Dacron graft and had an uneventful recovery. The case highlights the importance of early diagnosis and selection of appropriate imaging for this rare but serious iatrogenic sequel following percutaneous coronary intervention to minimize morbidity.

Type A aortic dissection during therapeutic coronary intervention in acute coronary syndrome: case report

Iatrogenic aortic dissection during coronary interventions is a rare complication and has heterogeneous management in the reviewed literature. We report a case of acute aortic syndrome of traumatic etiology, during a percutaneous coronary procedure, with its management, intra-hospital evolution, and one-year follow-up. A 65-year-old female who, during a percutaneous coronary intervention, presented an endothelium trauma of the left main artery's aorta-ostial transition by the tip of the guide catheter, leading to aortic dissection and occlusion of the left main artery with hemodynamic deterioration of the patient. The left main artery's flow was restored with drug-eluting stent implantation leading to a successful sealing of the false lumen with consequent hemodynamic stabilization. Immediate post-procedure transthoracic echocardiography showed a competent aortic valve. The patient evolved favorably and remains asymptomatic after one year.

Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective.

Iatrogenic aortic dissection (IAD) is a rare but devastating complication in cardiac surgery and related procedures. Due to its rarity, published data on emergency surgery following IAD are limited. Herein, we discuss IAD occurring intra- and postoperatively, including those occurring during transcatheter aortic valve replacement and cardiac catheterization, and present benchmark data from our consecutive, single-center experience. We demonstrate changes in patient characteristics, surgical approaches, and outcomes over a 23-year period.

Iatrogenic Aortic Dissection

Acute aortic dissection (Stanford Type A) is a life-threatening medical emergency associated with a high rate of early mortality (57 percent) without surgical intervention. During coronary catheterization, it occurs at a rate of 0.02 percent to 0.06 percent. There are no clear guidelines regarding the optimal management of this fatal condition. The critical importance of preventing dissection propagation by stenting the dissection's entrance in the coronary artery had been emphasized in prior review articles. Iatrogenic aortic dissections that do not involve the coronary arteries can be managed conservatively and closely followed-up with repeated imaging.

Spontaneous Resolution of Iatrogenic Aortic Dissection After Coronary Arterial Stenting

Although rare, coronary arterial angiography carries a life-threatening risk of iatrogenic aortic dissection (AD). Given the paucity of data, an optimal treatment option for iatrogenic AD is a conundrum. In this report, we present our experience of spontaneous resolution of AD in a patient with catheter-driven iatrogenic AD during coronary arterial intervention. (Level of Difficulty: Advanced.)

TCTAP C-109 Severe Iatrogenic Aortic Dissection Resolved in Five Days After Aorto-Ostial Stenting

TCTAP C-109 Severe Iatrogenic Aortic Dissection Resolved in Five Days After Aorto-Ostial Stenting

Recannulation of the right axillary artery in reoperative proximal thoracic aortic surgery is safe.

OBJECTIVESTo evaluate the safety and efficacy of recannulating the axillary artery in reoperative proximal thoracic aortic surgery.METHODSBetween 2008 and 2020, we evaluated patients who underwent reoperative proximal thoracic aortic surgery. The patients were divided into 2 groups: (i) patients with no previous right axillary artery cannulation (primary cannulation group) and (ii) patients with a previous cannulated right axillary artery (recannulation group). We analysed the intraoperative data, cannulation-related complications, postoperative outcomes and compared the 2 groups (primary cannulation versus recannulation).RESULTSThe patient (n = 132) baseline characteristics did not differ significantly between the 2 groups. There was no statistically significant difference in regard to the duration of surgery, cardiopulmonary bypass, aortic cross-clamp and antegrade cerebral perfusion time nor in regard to the total number of patients with cannulation-related complications between the 2 groups [n = 8 (8.0%) vs n = 1 (3.1%), P = 0.34]. The incidence of iatrogenic axillary artery dissection, iatrogenic aortic dissection, iatrogenic aortic dissection leading to death, axillary artery thrombosis, need for surgical repair, brachial plexus injury rates, malperfusion, high perfusion resistance and hyperperfusion syndrome revealed no significant difference between the 2 groups (P > 0.05). There were 11 (11.0%) cases of stroke in the primary cannulation group and 1 (3.1%) in the recannulation group (P = 0.18).CONCLUSIONSRecannulation of the right axillary artery in reoperative proximal thoracic aortic surgery is not associated with worse clinical outcomes and can be safely and effectively performed, also representing a preventive and rescue measure. Previous cannulation of the axillary artery should not hinder the decision for recannulation.

Iatrogenic aortic dissection of the descending aorta after percutaneous coronary intervention.

Aortic dissection is a rare and potentially fatal complication of coronary angiography. We report a case of a woman in her late 80s who underwent a left femoral approach coronary angiogram for evaluation of a transcatheter aortic valve replacement (TAVR). Following the procedure, she had a cardiac arrest and was found to have a descending aortic dissection on transoesophageal echocardiogram. Autopsy showed an acute intimal tear of the descending aorta, most likely related to catheter manipulation. Patients undergoing evaluation for TAVR, who tend to be elderly with concomitant atherosclerosis, are at risk for complications following cardiac catheterisation including aortic dissection.

Spontaneous Coronary Artery Dissection (SCAD) and a family history of aortic artery dissection, a case series

Abstract Background/Introduction SCAD typically affects women in their fifth or sixth decade with a paucity of cardiovascular risk factors.(1) It is caused by a coronary artery intramural haematoma with or without intimal tear. Resultant luminal occlusion manifests as myocardial ischaemia/infarction or death. There are two published sporadic cases of SCAD who developed iatrogenic aortic dissection with coronary angiography.(2, 3) We are not aware of any SCAD cases with intercurrent or historical spontaneous aortic dissection. There is a published SCAD case with a familial history of aortic dissection, in her mother.(4) None of these cases reported a connective tissue disorder. Methods We searched our database of 338 SCAD cases, recruited via social media or cardiologist referral, for cases with a family history of aortic dissection. SCAD diagnosis was confirmed by review of coronary angiogram images by an expert interventional cardiologist blinded to the genetic analysis. Genomic DNA was extracted from buccal cells collected using a cheek swab or mouthwash sample. Whole genome sequencing was performed using the Illumina HiSeq X Ten platform with 30x coverage. These data are being analysed for rare variants in genes associated with familial aortopathies or connective tissue disorders (e.g. FBN1, COL3A1, TGFbR-1/2, SMAD3), as well as for novel gene associations with aortic dissection and/or SCAD. Results We identified 12 cases with a first- or second-degree relative with aortic dissection. Of these SCAD cases, 11 were female whereas 10 of 12 relatives with aortic dissection were male. In one instance, a maternal uncle, but not the index SCAD case, had Marfan's syndrome. Whole genome sequencing has been performed on the 12 SCAD cases, 2 living relatives with aortic dissection and 2 relatives linking the SCAD and aortic dissection cases. Conclusions Coronary and aortic dissections have serious consequences and in some families there may be a genetic association between the two conditions. Early identification of variant carriers is critical for disease prevention. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported in part by grants from the Cardiac Society of Australia and New Zealand, the National Health and Medical Research Council, Australia (APP1161200), the St Vincent's Clinic Foundation, the Catholic Archdiocese of Sydney, Perpetual Philanthropy, NSW Health and SCAD Research Inc. LMC is funded by a University Postgraduate Scholarship through University of NSW and a grant from the Avant Foundation.

Antegrade Perfusion for Mini-Thoracotomy Mitral Valve Surgery in Patients with Atherosclerotic Burden

The relationship between retrograde arterial perfusion and stroke in patients with peripheral vascular disease has been widely documented. Antegrade arterial perfusion has been favoured as an alternative approach in less invasive mitral valve (MV) operations. We aimed to analyse our experience in patients with peripheral arterial disease undergoing MV surgery through a right mini-thoracotomy adopting antegrade arterial perfusion. A single-institution retrospective study on prospectively collected data was performed on patients undergoing right mini-thoracotomy MV surgery with antegrade arterial perfusion. Since 2009, indication for the latter was dictated by the severity of atherosclerotic burden. Preoperative screening included computed tomography, angiography, or both for the evaluation of the aorta and ileo-femoral arteries. Consecutive patients (n=117) underwent MV surgery through a right mini-thoracotomy with antegrade arterial perfusion, established either by transthoracic central aortic cannulation in 65 (55.6%) cases or by axillary arterial cannulation in 52 (44.4%). Mean logistic EuroSCORE was 11%±2.3%. Twenty-five (25) (21.4%) patients had undergone one or more previous cardiac operations. Operative mortality was 4.3% (n=5). Nonfatal iatrogenic aortic dissection occurred in one case (0.8%). The incidence of stroke was zero. Axillary or central aortic cannulation is a promising alternative route to provide excellent arterial perfusion in right mini-thoracotomy MV surgery, with a very low incidence of stroke and other major perioperative complications in patients with severe aortic or peripheral arterial disease.

Endovascular repair of aortic perforation and type B aortic dissection after axillary intra-aortic balloon pump insertion

We present the successful endovascular repair of an iatrogenic aortic dissection in a 57-year-old woman with decompensated heart failure. An intra-aortic balloon pump was inserted in the patient via a percutaneous axillary approach for circulatory support. Six days later, she developed symptoms of abdominal pain and lower extremity malperfusion. Computed tomography angiography demonstrated a type B aortic dissection with associated retroperitoneal hematoma secondary to aortic perforation. The patient underwent emergent endovascular aortic repair and intra-aortic balloon pump removal with return of lower extremity perfusion. She recovered well and underwent heart and kidney transplant less than 2 months postoperatively.

Massive Iatrogenic Aortic Dissection During Percutaneous Coronary Intervention.

Massive Iatrogenic Aortic Dissection During Percutaneous Coronary Intervention.

TCTAP C-062 Iatrogenic Retrograde Coronary Aortic Dissection During Coronary Intervention: Rare But Life-threatening

TCTAP C-062 Iatrogenic Retrograde Coronary Aortic Dissection During Coronary Intervention: Rare But Life-threatening