title: Iatrogenic Catheter-Induced Acute Aortic Dissection Type A after Coronary Angiography-A Retrospective Consecutive Case Series.
abstract: BackgroundAcute aortic dissection type A (AADA) is one of the most life-threatening situations and surgical demanding procedures even today. Usually AADA develops spontaneously, but it can be related also to interventional procedures.MethodsWe analyzed the data of 14 patients surgically treated in our institution with catheter-induced AADA (ciAADA) during coronary angiography between January 2004 and December 2014. Data were compared with overall AADA patients in this time period (n= 288).ResultsNine of the 14 patients were female. Subjects were significantly older compared to the AADA patients (69 ± 11 vs. 62 ± 11;p= 0.021). At admission, ciAADA patients were more often hemodynamically instable and mechanically ventilated. Twelve patients underwent replacement of the ascending aorta and two patients received a modified Bentall operation. Cardiopulmonary bypass time (210 ± 92 vs. 172 ± 51 min) and cross-clamp time (122 ± 63 vs. 92 ± 40 min) were significantly longer due to additional coronary artery bypass grafts in 71.4 versus 3.1% due to myocardial ischemia. Operative mortality (7.1 vs. 2.1%,p= 0.29) and 30-day mortality (50.0 vs. 10.7%,p< 0.001) were higher in the ciAADA group.ConclusionCoronary angiography-induced AADA is a rare but severe complication. Due to additional myocardial ischemia and preoperative hemodynamic instability, patients with ciAADA have adverse outcome compared to overall AADA patients.
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Huenges
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Dreyer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Panholzer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Grothusen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.affiliation: Department of Diagnostic Radiology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schäfer
authors.affiliation: Hospital Medicine, Saint Bernards Medical Center, Jonesboro, Arkansas, United States.
authors.forename: Miriam
authors.initials: M
authors.lastname: Freundt
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schoeneich
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schöttler
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Azizolah
authors.initials: A
authors.lastname: Rahimi-Barfeh
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001011:Aorta / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D062906:Cardiac Catheters; D017023:Coronary Angiography / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery