Improving Outcomes of Iatrogenic Type A Aortic Dissection during Cardiac Surgery.
Journal
Aorta (Stamford, Conn.)
ISSN: 2325-4637
Titre abrégé: Aorta (Stamford)
Pays: Germany
ID NLM: 101655549
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
pubmed:
27
11
2019
medline:
27
11
2019
entrez:
27
11
2019
Statut:
ppublish
Résumé
Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a standardized approach to management. From January 1, 2000 through December 31, 2016, 23,275 patients underwent cardiac surgery at our institution. We identified 15 patients who developed IAD. Our approach to management included (1) immediate repair, (2) involvement of a second attending surgeon, (3) aggressive monitoring of malperfusion, (4) securing true lumen arterial perfusion access and systemic cooling, and (5) performance of hemiarch or total arch replacement based on the presence of suspected brain malperfusion. The index operation was also completed at the same time. Patient preoperative characteristics, operative sequence and technique, complications, and outcomes were analyzed with chart review. The incidence of IAD at our institution was 0.06% ( Incidence of IAD is low with cannulation of an aneurysmal aorta being a risk factor. A standardized approach may result in reduced operative mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a standardized approach to management.
METHODS
METHODS
From January 1, 2000 through December 31, 2016, 23,275 patients underwent cardiac surgery at our institution. We identified 15 patients who developed IAD. Our approach to management included (1) immediate repair, (2) involvement of a second attending surgeon, (3) aggressive monitoring of malperfusion, (4) securing true lumen arterial perfusion access and systemic cooling, and (5) performance of hemiarch or total arch replacement based on the presence of suspected brain malperfusion. The index operation was also completed at the same time. Patient preoperative characteristics, operative sequence and technique, complications, and outcomes were analyzed with chart review.
RESULTS
RESULTS
The incidence of IAD at our institution was 0.06% (
CONCLUSIONS
CONCLUSIONS
Incidence of IAD is low with cannulation of an aneurysmal aorta being a risk factor. A standardized approach may result in reduced operative mortality.
Identifiants
pubmed: 31770775
doi: 10.1055/s-0039-1695729
pmc: PMC6914357
doi:
Types de publication
Journal Article
Langues
eng
Pagination
115-120Subventions
Organisme : NHLBI NIH HHS
ID : T35 HL007616
Pays : United States
Informations de copyright
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest related to this article.
Références
Circulation. 1984 Sep;70(3 Pt 2):I153-64
pubmed: 6235061
Eur J Cardiothorac Surg. 2012 Mar;41(3):641-6
pubmed: 22345184
Asian Cardiovasc Thorac Ann. 2015 Jan;23(1):31-5
pubmed: 24719163
Interact Cardiovasc Thorac Surg. 2006 Feb;5(1):11-4
pubmed: 17670501
JAMA. 2000 Feb 16;283(7):897-903
pubmed: 10685714
Ann Thorac Surg. 1992 Mar;53(3):374-9; discussion 380
pubmed: 1540051
Circulation. 1998 Nov 10;98(19 Suppl):II294-8
pubmed: 9852917
Ann Thorac Surg. 2010 Dec;90(6):1812-6; discussion 1816-7
pubmed: 21095316
Ann Thorac Surg. 1999 Jun;67(6):2006-9; discussion 2014-9
pubmed: 10391359
Surgery. 1982 Dec;92(6):1118-34
pubmed: 7147190