Acute type A aortic dissection with a tear in the posterior wall of the ascending aorta early after off-pump coronary artery bypass grafting.
Aortic dissection
Iatrogenic disease
Off-pump coronary artery bypass
Journal
General thoracic and cardiovascular surgery
ISSN: 1863-6713
Titre abrégé: Gen Thorac Cardiovasc Surg
Pays: Japan
ID NLM: 101303952
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
15
07
2020
accepted:
01
11
2020
pubmed:
18
11
2020
medline:
24
4
2021
entrez:
17
11
2020
Statut:
ppublish
Résumé
The patient was a 68-year-old man who underwent triple-vessel OPCAB uneventfully with aortic proximal anastomosis at one site using the saphenous vein with a mechanical device, not a side clamp, with mild traction of the ascending aorta by aortic taping. On postoperative day 7, computed tomography revealed extremely localized AAD with a tear on the posterior wall of the ascending aorta. Emergent ascending aortic replacement was successfully performed. Surprisingly, the tear extended laterally along the traction site of the tape. To our knowledge, this is the first report of AAD early after OPCAB originating at a location other than the sites of proximal anastomosis or side clamping. Proximal anastomosis with a mechanical device to the towed aorta may indirectly or directly injure the intima of the posterior wall, causing this complication. Manipulating the aorta under abnormal pressure should be avoided.
Identifiants
pubmed: 33201384
doi: 10.1007/s11748-020-01547-4
pii: 10.1007/s11748-020-01547-4
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
870-873Références
Chavanon O, Carrier M, Cartier R, Hébert Y, Pellerin M, Pagé P, et al. Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery? Ann Thorac Surg. 2001;71:117–21.
doi: 10.1016/S0003-4975(00)02136-6
Tabry IF, Costantini EM. Acute Aortic Dissection Early after Off-Pump Coronary Surgery:true frequency underestimated? Tex Heart Inst J. 2009;36:462–7.
pubmed: 19876430
pmcid: 2763454
Stanger O, Schachner T, Gahl B, Oberwalder P, Englberger L, Thalmann M, et al. Type A aortic dissection after nonaortic cardiac surgery. Circulation. 2013;128:1602–11.
doi: 10.1161/CIRCULATIONAHA.113.002603
Buffolo E, Branco JN, Gerola LR, Aguiar LF, Teles CA, Palma JH, et al. Off-pump myocardial revascularization: critical analysis of 23 years’ experience in 3,866 patients. Ann Thorac Surg. 2006;81:85–9.
doi: 10.1016/j.athoracsur.2005.07.032
Demers P, Cartier R. Multivessel off-pump coronary artery bypass surgery in the elderly. Eur J Cardiothorac Surg. 2001;20:908–12.
doi: 10.1016/S1010-7940(01)00973-3
Syburra T, Reuthebuch O, Graves K, Genoni M. Aortic posterior wall perforation with automatic aortic cutter during routine off-pump coronary bypass grafting. Interact Cardiovasc Thorac Surg. 2009;9:840–1.
doi: 10.1510/icvts.2009.211078