title: Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients.
abstract: OBJECTIVE
  Iatrogenic aortic dissection (IAD) is a rare complication of cardiac procedures. We herein describe our management and results of this complication.
  
  
  METHODS
  A total of 55 279 patients underwent open heart surgery at our centre from 1995 to 2010, and 135 262 patients underwent cardiac catheterization over the same time period. We identified 48 patients from this cohort who underwent emergency surgery for IAD that occurred either during or shortly after cardiac surgery, or following cardiac catheterization.
  
  
  RESULTS
  The incidence of IAD was 0.06% (n = 36) for cardiac surgical procedures and 0.01% (n = 12) for cardiac catheterization procedures. The mean patient age was 66 ± 14 years and 50% were female. Intraoperative IAD occurred during aortic cannulation in 12 patients, insertion of the cardioplegia cannula in 7 patients, manipulation of the aortic crossclamp in 4 patients or during other events in 8 patients. IAD occurred early postcardiac surgery in 5 patients, and during cardiac catheterization in the remaining 12 patients. IAD was treated by emergent replacement of the ascending aorta and the aortic arch (when involved), as well as aortic root replacement or repair as indicated. Early mortality was 41.7: 35.5% for intraoperative IAD, 60.0% for postoperative IAD and 50.0% for cardiac catheterization-associated IAD (P = 0.5). Histological investigation revealed atherosclerosis in 61.2% of patients, cystic medial necrosis in 22.2%, aortitis in 2.8% and other pathologies in 13.8%. Follow-up was 100% complete with a 5-year survival of 40 ± 0.4%.
  
  
  CONCLUSIONS
  IAD is a rare but dangerous complication of cardiac surgery and cardiac catheterization, and is frequently associated with pre-existing aortic pathology.
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. serg_leontyev@web.de
authors.forename: Sergey
authors.initials: S
authors.lastname: Leontyev
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Legare
authors.forename: Denis
authors.initials: D
authors.lastname: Merk
authors.forename: Jochen
authors.initials: J
authors.lastname: Hahn
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Sven
authors.initials: S
authors.lastname: Lehmann
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome