title: Type A aortic dissection after nonaortic cardiac surgery.
abstract: BACKGROUND
  Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occasionally leads to type A aortic dissection (AAD).
  
  
  RESULTS
  One hundred three patients with surgical repair for AAD following nonaortic cardiac surgery were identified. With the use of logistic regression modeling, coronary artery bypass surgery (CABG), either isolated or combined with another procedure in the initial operation, was associated with significantly higher operative mortality in comparison with patients with non-CABG procedures at the time of AAD repair both for all patients (odds ratio, 2.90; 95% confidence interval, 1.09-7.72; P=0.033) and for patients with acute and chronic AAD≥30 days after the initial operation (odds ratio, 3.62; 95% confidence interval, 1.13-11.54; P=0.03). In patients who developed AAD late after the initial operation, operative mortality was highest in patients without preoperative coronary angiography and appropriate management of their native coronary artery disease and graft disease (odds ratio, 5.36; 95% confidence interval, 1.68-17.0; P=0.002). Nearly all the intimal dissection tears were located at sites of previous surgical trauma. Most of the ascending aortas that had dissected initially had a diameter≥40 mm with histological evidence of medial degeneration in resected tissue samples.
  
  
  CONCLUSIONS
  In patients who have undergone previous cardiac surgery, preexisting aortic wall pathology contributes to AAD with typical intimal damage at sites of mechanical trauma. The operative mortality was the highest in patients with previous CABG in comparison with patients with non-CABG procedures. Preoperative coronary angiography and operative management of native coronary and graft disease were significantly associated with outcome in patients with previous CABG.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne (Inselspital), Berne, Switzerland (O.S., B.G., L.E., T.C.); Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria (T.S.); University Clinic of Cardiac Surgery, Medical University Graz, Graz, Austria (P.O.); Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria (M.T.); Department of Cardiothoracic Surgery, The Liverpool Heart and Chest Hospital, Liverpool, UK (D.H., M.F.); Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria (D.W.); University Cardiovascular Centre Freiburg-Bad Krotzingen, Freiburg, Germany (M.S., B.R.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK (M.N.S.); Department of Cardiac Surgery, Oxford University NHS Hospitals, Oxford, UK (M.P.); Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH (J.B.); and Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK (J.P.).
authors.forename: Olaf
authors.initials: O
authors.lastname: Stanger
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.forename: Peter
authors.initials: P
authors.lastname: Oberwalder
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Markus
authors.initials: M
authors.lastname: Thalmann
authors.forename: Debbie
authors.initials: D
authors.lastname: Harrington
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.forename: Michael
authors.initials: M
authors.lastname: Südkamp
authors.forename: Mary N
authors.initials: MN
authors.lastname: Sheppard
authors.forename: Mark
authors.initials: M
authors.lastname: Field
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rylski
authors.forename: Mario
authors.initials: M
authors.lastname: Petrou
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.forename: John
authors.initials: J
authors.lastname: Pepper
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology / Q000401:mortality*; D001011:Aorta; D001014:Aortic Aneurysm / Q000209:etiology / Q000401:mortality*; D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000209:etiology / Q000401:mortality*; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies
keywords: aorta; cardiopulmonary bypass; hypertension; pathology; surgery