John F. Kennedy Hospital, Talatpasa Bulvari, Begonya Sokak, No: 7-9 Bahcelievler 34590 Istanbul, Turkey.
Kardiol Pol. 2009 Aug;67(8):858-63.
Aortic dissection is associated with high mortality. Despite its rarity, it is often fatal.
We have retrospectively analysed acute aortic dissections occurring intraoperatively (IAAD).
Patients' preoperative risk factors, and operative and postoperative courses were analysed from the hospital records retrospectively.
From 1985 to 2009, we performed 29 683 cardiac operations. Ten patients (0.43 per thousand) (mean age 66.5+/-7 years) were diagnosed with IAAD. There were type 2 dissections in 9 and one patient had it extending beyond the arcus. Four patients were operated on for coronary artery disease, 2 for mitral and 2 for aortic valve diseases. Two patients had concomitant valvular or valvular and coronary procedures. IAAD was identified after decannulation in 5, after creating the holes for proximal anastomoses in 3 and after declamping the aorta in 2 patients. Preoperatively, 6 (60%) patients had hypertension and 4 had hypercholesterolaemia (40%). No other significant risk factors could be identified. Hypothermic circulatory arrest was used in 6 operations. The dissected segment was replaced with a graft in 9 patients whereas the remaining patient had concomitant arcus aorta replacement and elephant trunk procedure. Aortoplasty with Dacron patch was used in one patient. All patients required inotropic and 4 patients IABP support postoperatively. Three (30%) patients died.
The IAAD may occur in any patient at any phase of cardiac surgery. The surgeon should always be aware of the possibility of this complication. It is much better to prevent the IAAD than to treat it. When detected, abrupt change of the operation plan and reparative measures for the dissection should be undertaken.
主动脉夹层与高死亡率相关。尽管其发病率较低，但往往是致命的。
我们回顾性分析了术中发生的急性主动脉夹层（IAAD）。
从医院病历中回顾性分析患者术前的危险因素、手术过程和术后过程。
1985 年至 2009 年，我们进行了 29683 例心脏手术。10 例患者（千分之 0.43）（平均年龄 66.5+/-7 岁）被诊断为 IAAD。9 例为 2 型夹层，1 例延伸至弓部。4 例患者因冠状动脉疾病接受手术，2 例因二尖瓣疾病，2 例因主动脉瓣疾病接受手术。2 例患者同时进行瓣膜或瓣膜和冠状动脉手术。5 例在拔管后、3 例在近端吻合口打孔后和 2 例在主动脉钳夹后发现 IAAD。术前 6 例（60%）患者有高血压，4 例（40%）有高胆固醇血症。未发现其他明显的危险因素。6 例手术中使用了低温体外循环。9 例患者用移植物置换夹层段，1 例患者同时进行弓状主动脉置换和象鼻手术。1 例患者使用涤纶补丁进行主动脉成形术。所有患者术后均需要使用正性肌力药物和 4 例患者需要使用主动脉内球囊反搏支持。3 例（30%）患者死亡。
IAAD 可发生在心脏手术的任何阶段的任何患者。外科医生应始终意识到这种并发症的可能性。预防 IAAD 比治疗它更好。当发现 IAAD 时，应立即改变手术计划，并采取修复夹层的措施。
