title: [Anesthetic management of intraoperative aortic dissection during cardiovascular surgery].
abstract: Despite considerable advances in anesthesia technique, intraoperative aortic dissection remains a potentially lethal complication during on-pump cardiovascular surgery. Intraoperative dissection has been described worldwide, ranging between 0.06% and 0.24%. Here we present 8 patients who had intraoperative dissection during 10-year period with 6,266 on-pump cases (0.13%, 95% confidence interval 0.12% to 0.14%). In-hospital mortality rate of intraoperative dissection was 12.5% (1/8) at our institution, which was exceptionally lower than that reported previously (24% to 43%). Therefore, we also show our treatment strategy for intraoperative dissection with the related-literature review. The original surgical procedures were descending aortic replacement in 3 patients, valve replacement in 4 patients, and aortic-root replacement in 1 patient. Dissection occurred during aortic cannulation in 6 patients and during manipulation of aortic cross-clamping/de-clamping in 2 patients. Three patients had retrograde dissection extending and beyond the arch. Trans-esophageal echocardiography was useful to confirm dissection and ensure proper perfusion of the aortic-branches. Immediately after its diagnosis, all patients were managed with hypotensive strategy and subsequently underwent deep hypothermic circulatory arrest for prevention of dissection propagation. Among patients with intraoperative aortic dissection undergoing on-pump cardiovascular surgery, not only earlier diagnosis but proper anesthetic management may be crucial for the successful outcome.
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kamei
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyazaki
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Eri
authors.initials: E
authors.lastname: Miyake
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita 565-8565.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ohnishi
mesh_terms: D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures; D050792:Circulatory Arrest, Deep Hypothermia Induced; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019990:Perioperative Care; D016896:Treatment Outcome