Late acute aortic dissection after coronary artery bypass.

INTRODUCTION

Late ascending aortic dissection after coronary artery bypass grafting (CABG) is an uncommon phenomenon, and treatment presents a complex clinical dilemma.

MATERIALS AND METHODS

Between 1995 and 2005, eight patients were diagnosed with post-CABG late acute aortic dissection. Mean age was 61.7 (range 52-76), and mean period between CABG and late acute aortic dissection was 45.3 months (range 5 to 122 months). Three patients underwent surgical replacement of the ascending aorta. One patient died after surgery, and the other two had an uneventful recovery, with a successful mean 6.5-year follow-up. Five patients were treated conservatively, with a mean follow-up of 81.2 months (range 50-112 months).

RESULTS AND DISCUSSION

Periodic computed tomography (CT) scans showed minor or no change in aortic diameter and satisfactory general condition. Late acute aortic dissection after CABG is rare. Only a few reports have been published, and no standard treatment guidelines exist.

CONCLUSION

We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection and therefore suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial. Late ascending aortic dissection after CABG is rare, and treatment presents a clinical dilemma. We treated eight patients with post-CABG late acute aortic dissection. Three underwent surgical replacement of the ascending aorta. One died after surgery, and the other two had an uneventful recovery. Five patients were treated conservatively. No standard treatment guidelines exist for late acute aortic dissection after CABG. We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection, and suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial.