Intraoperative Aortic Dissection Complicating Elective Off-pump Coronary Artery Bypass Surgery

Özet

Aim: We conducted this study to identify current trends and risk factors for iatrogenic dissection. Methods: From December 2013 to November 2017 in Republican Research Center for Emergency Medicine, 711 patients (mean age 54+∕-2,3 years old) were operated electively. Off-pump coronary artery bypass grafting procedures was performed in all cases. Patients’ preoperative risk factors, and operative and postoperative courses were analyzed from the hospital records retrospectively. Results: Of the 711 patients, who had off-pump coronary artery bypass, 2 (0.28%) developed iatrogenic intraoperative aortic dissection. Patients with the iatrogenic aortic dissection were in older age group (62 and 68 years old). Both patients had dissection extending beyond the aortic arch. IAAD was identified after removing the side clamp from the aorta in both patients; however, the intimal tear was located on the site of proximal anastomosis. Preoperatively, 2 (100%) patients had arterial hypertension and ascending aorta atherosclerosis. No other significant risk factors could be identified. One patient died due to intraoperative complete aortic rupture. In another case the dissected segment was replaced with a graft and proximal anastomoses were replanted in it under the hypothermic circulatory arrest. This patient required inotropic and respiratory support postoperatively. Mortality rate was 100%, second patient died due to respiratory distress on 10th postoperative day. Conclusions: Intraoperative aortic dissection is an unpredictable and often fatal complication of cardiac surgery. Regarding to our data overall incidence of iatrogenic type A aortic dissections was 0,28%. Increased age, high blood pressure and atheromatous disease of the ascending aorta could be significant risk factors for iatrogenic dissection in our series. Surgical interventions for iatrogenic aortic dissections require further improvement of surgical techniques and perioperative management.