Iyengar Amit, Kelly John J, Catalano Michael, Helmers Mark, Patrick William L, Grimm Joshua, Bavaria Joseph E, Desai Nimesh D
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg Short Rep. 2023 Feb 27;1(2):272-276. doi: 10.1016/j.atssr.2023.02.011. eCollection 2023 Jun.
Iatrogenic type A aortic dissection is a rare complication of surgical and nonsurgical cardiac procedures associated with high morbidity. The purpose of this study was to describe the intraoperative incidence, surgical management, and outcomes of iatrogenic type A dissections at our institution.
Retrospective review of our institution's adult cardiac surgery database was performed between 2002 and 2018 to identify all iatrogenic type A aortic dissection repairs. Operative reports were reviewed for cause of dissection and repair strategy. Follow-up surveillance for mortality and need for aortic reintervention was queried as available.
Overall, 36 patients undergoing iatrogenic type A repairs were identified (cardiac surgical incidence, 0.1%). Of these, 23 (63.9%) were related to open operation, 5 (13.9%) to percutaneous coronary interventions, 5 (13.9%) to thoracic endovascular repairs, and 3 (8.3%) to other endovascular procedures. Most patients underwent hemiarch repairs under circulatory arrest (28/36 [77.8%]), whereas total arch repair was required in 5 of 36 (13.9%). Among all patients, in-hospital mortality was 36.1% (13/36). Those who survived to discharge had low subsequent mortality, with no differences between endovascular and surgical causes ( = .797). On median follow-up of 3.1 years, need for redo aortic surgery was limited to 4 (11.1%) patients, all successfully treated with endovascular therapy.
Iatrogenic type A dissections represent a rare but serious complication of cardiac procedures, with high in-hospital mortality for those undergoing surgical repair. A repair strategy involving an open distal anastomosis and proximal root reconstruction ensures durable freedom from need for redo surgery.
医源性A型主动脉夹层是心脏手术和非心脏手术中一种罕见的并发症，发病率较高。本研究的目的是描述我院医源性A型夹层的术中发生率、手术治疗及预后情况。
回顾性分析我院2002年至2018年成人心脏手术数据库，以确定所有医源性A型主动脉夹层修复病例。查阅手术报告以了解夹层原因和修复策略。查询随访期内的死亡率及再次进行主动脉干预的必要性。
共确定36例接受医源性A型修复的患者（心脏手术发生率为0.1%）。其中，23例（63.9%）与开放手术有关，5例（13.9%）与经皮冠状动脉介入治疗有关，5例（13.9%）与胸段血管腔内修复有关，3例（8.3%）与其他血管腔内手术有关。大多数患者在循环阻断下进行半弓修复（28/36 [77.8%]），而36例中有5例（13.9%）需要进行全弓修复。所有患者中，住院死亡率为36.1%（13/36）。存活出院的患者后续死亡率较低，血管腔内手术和外科手术导致的死亡率无差异（P = 0.797）。中位随访3.1年时，再次进行主动脉手术的需求仅限于4例（11.1%）患者，均成功接受血管腔内治疗。
医源性A型夹层是心脏手术中一种罕见但严重的并发症，接受手术修复的患者住院死亡率较高。采用开放远端吻合和近端根部重建的修复策略可确保持久避免再次手术的需求。
