Perioperative type I aortic dissection during conventional coronary artery bypass surgery: risk factors and management.
OBJECTIVE
Perioperative iatrogenic type I aortic dissection (PIAD) is a rare but potentially fatal complication of conventional coronary artery bypass surgery (CCABG). Prompt recognition and repair of PIAD may significantly improve outcomes.


METHODS
We reviewed the hospital records of patients with PIAD occurring as a complication of CCABG at Siyami Ersek Thoracic and Cardiovascular Surgery Center from January 2001 through June 2007. During this period, 10,130 CCABG were performed and 21 patients (0.20%) with PIAD were identified. We compared variables for these 21 patients with 603 patients without PIAD (control group).


RESULTS
PIAD occurred intraoperatively in 19 patients (90%) and during the early postoperative period (first 6 hours) in 2 patients (10%) who underwent CCABG. Dissections were noticed after removal of the aortic crossclamp in 11 patients, during aortic cannulation in 3 patients, and after removal of the partial-occlusion clamp in 5 patients. Patients with and without PIAD differed significantly in regard to sex (P = .05), history of hypertension (P = .001), and history of severe concomitant peripheral arterial disease (PAD) (P = .001). The diameter of the aorta was significantly wider in patients with PIAD. (3.83 +/- 0.9 vs 2.93 +/- 0.46 cm, P = .019). The occurrence of high cardiopulmonary bypass (CPB) pressure (>==120 mmHg) was significantly higher in the PIAD patients than the non-PIAD patients (28.6% vs 3.3%, P = .0001). Seven PIAD patients (33.3%) died preoperatively and 3 (14.2%) died postoperatively.


CONCLUSIONS
PIAD is frequently fatal. Risk factors for PIAD during or after CCABG include female sex, history of PAD and hypertension, increased aortic diameter, and high CPB pressure.
Ketenci
Bulend
B
Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Istanbul, Turkey. bulendketenci@gmail.com
Enc
Yavuz
Y
Ozay
Batuhan
B
Gunay
Rafet
R
Cimen
Serdar
S
Gorur
Alper
A
Tuygun
Abdullah Kemal
AK
Sargin
Murat
M
Sari
Sibel
S
Demirtas
Mahmut Murat
MM
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors