Wang Yulin, Liu Fangyu, Song Kai, Lai Hao, Sun Yongxin, Li Jun, Wang Chunsheng, Ji Qiang
Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University, 200032 Shanghai, China.
Shanghai Municipal Institute for Cardiovascular Diseases, 200032 Shanghai, China.
Rev Cardiovasc Med. 2022 Apr 12;23(4):140. doi: 10.31083/j.rcm2304140. eCollection 2022 Apr.
To investigate short- and intermediate-term outcomes of immediate (on table) recognition and surgical treatment of iatrogenic acute type A aortic dissection (ATAD) that occurred during the course of the cardiac surgical procedures.
Of 23,143 adult patients undergoing cardiac surgical procedures at our institution from January 2016 to December 2020, 21 (0.09%) suffered from intraoperative iatrogenic ATAD and underwent immediate aortic repair. Their clinical characteristics, in-hospital outcomes and follow-up results were analyzed.
Among the 21 patients, 13 (61.9%) suffered from hypertension, and 14 (66.7%) had a dilated ascending aorta. In-hospital mortality was 9.5%, and new onset of permanent neurologic deficit was recorded in one patient. During a median follow-up of 36.0 months, all 18 follow-up patients survived without repeated surgeries. A follow-up computed tomography (CT) examination revealed a residual false lumen in the aortic arch in 3 patients and in the descending aorta in 8, with residual false lumen perfusion in one.
Immediate recognition and surgical repair of ATAD that developed as a complication during cardiac surgical procedures are associated with low mortality and high intermediate-term survival.
探讨心脏外科手术过程中发生的医源性急性A型主动脉夹层（ATAD）即刻（术中）识别及手术治疗的短期和中期结果。
在2016年1月至2020年12月期间于我院接受心脏外科手术的23143例成年患者中，21例（0.09%）发生术中医源性ATAD并接受了即刻主动脉修复。分析了他们的临床特征、住院结局及随访结果。
21例患者中，13例（61.9%）患有高血压，14例（66.7%）升主动脉扩张。住院死亡率为9.5%，1例患者出现永久性神经功能缺损新发。在中位随访36.0个月期间，18例接受随访的患者均存活，无需再次手术。随访计算机断层扫描（CT）检查显示，3例患者主动脉弓存在残余假腔，8例患者降主动脉存在残余假腔，1例存在残余假腔灌注。
心脏外科手术过程中作为并发症发生的ATAD即刻识别及手术修复与低死亡率和高中期生存率相关。
