Retrograde aortic dissection during cardiopulmonary bypass: "nonoperative" management.
Seven patients are reported in whom retrograde aortic dissection occurred, 2 during valve replacement and 5 during coronary artery bypass, among 770 patients perfused through the common femoral artery. Successful management included : (1) immediate cessation of cardiopulmonary bypass; (2) removal of the arterial cannula and its replacement in the ascending aorta, usually through both lumens of the dissection; (3) completion of the operation by suturing the proximal ends of saphenous vein grafts to both lumens of the dissection in the ascending aorta; and (4) no treatment of the dissection itself. One patient died of other causes 30 days postoperatively. Follow-up from 2 to 3 1/2 years in 6 long-term survivors has revealed no complications related to the dissection. Saphenous vein graft function is apparently satisfactory.
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology; D001014:Aortic Aneurysm / Q000209:etiology* / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation; D014182:Transplantation, Autologous