Acute ascending aortic dissection complicating open heart surgery: cerebral perfusion defines the outcome

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Serval ID
serval:BIB_A20505AF74BC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Acute ascending aortic dissection complicating open heart surgery: cerebral perfusion defines the outcome
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Ruchat  P., Hurni  M., Stumpe  F., Fischer  A. P., von Segesser  L. K.
ISSN
1010-7940 (Print)
Publication state
Published
Issued date
11/1998
Volume
14
Number
5
Pages
449-52
Notes
Journal Article --- Old month value: Nov
Abstract
OBJECTIVE: This retrospective study was designed to assess the risks of acute ascending aorta dissection (AAD) as a rare but potentially fatal complication of open heart surgery. METHOD: Among 8624 cardiac surgical procedures under cardiopulmonary bypass (CPB) and cardioplegic myocardial protection from 1978 to 1997, 10 patients (0.12%) presented with a secondary or so called 'iatrogenic' AAD. There were seven men and three women, mean age 64 +/- 9 years, ranging from 47 to 79. The original procedures involved five coronary artery bypass grafts (CABG), one repeat CABG, one aortic valve replacement (AVR), one AVR and CABG, one mitral valvuloplasty (MVP) and CABG and one ascending aorta replacement. We retrospectively analyzed their hospital records. RESULTS: Group I consisted of seven patients with AAD intraoperatively and group II consisted of three patients who developed acute AAD 8-32 days after cardiac surgery. In group I, treatment consisted of the original procedure, plus grafting of the ascending aorta in six patients and closed plication and aortic wrapping in one. In group II, two patients received a dacron graft and one patient developed lethal tamponnade due to aortic rupture before surgery. Postoperatively, six patients responded well and three died (33%), two patients from group I on the 2nd postoperative day with severe post-anoxic encephalopathy, and one from group II with severe peroperative cardiogenic shock. CONCLUSION: Preventing AAD with the appropriate means remains standard practice in cardiac surgery. If AAD occurs, it requires prompt diagnosis and interposition graft to allow a better prognosis. Intraoperative AAD happens at the beginning of CPB jeopardizing perfusion of the supra-aortic arteries.
Keywords
Acute Disease Aged Aneurysm, Dissecting/epidemiology/*etiology/surgery Aorta/injuries/surgery Aortic Aneurysm/epidemiology/*etiology/surgery Blood Vessel Prosthesis Implantation *Cardiac Surgical Procedures Cardiopulmonary Bypass Case-Control Studies Cerebrovascular Circulation/*physiology Female Heart Arrest, Induced Humans Intraoperative Care Intraoperative Complications/*epidemiology Male Middle Aged Perfusion Postoperative Complications/*epidemiology Retrospective Studies Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:39
Last modification date
25/09/2019 7:10
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