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Delayed chronic type A dissection following CABG: implications for evolving techniques of revascularization.
1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA. chagl@hotmail.com
Journal of Cardiac Surgery
|October 16, 2001
Summary
Type A aortic dissection after coronary artery bypass grafting (CABG) often originates at the partial occlusion clamp site. This complication leads to significant morbidity and mortality, highlighting the need for careful surgical technique.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic dissection is a serious complication following cardiac surgery, with manipulation of the aorta contributing to 3-5% of deaths.
- Chronic type A dissection after prior cardiac operations presents a significant clinical challenge.
Purpose of the Study:
- To investigate the etiology and outcomes of type A aortic dissection in patients with a history of coronary artery bypass grafting (CABG).
- To identify the specific sites of intimal tears and associated risk factors in post-CABG aortic dissection.
Main Methods:
- Review of 21 patients who underwent reoperation for type A aortic dissection after isolated CABG between 1987 and 1999.
- Analysis of surgical techniques, including clamp sites, aortic diameter, and type of aortic repair (Bentall procedure vs. supracoronary anastomosis).
Main Results:
- The intimal tear was most frequently located at the partial occlusion clamp site (57.1%).
- Severe atherosclerosis and cystic media necrosis were common comorbidities (47.6% and 9.5%, respectively).
- Hospital mortality was 9.5%, with a 14.3% rate of postoperative stroke; 85.7% freedom from cardiac or aorta-related mortality at follow-up.
Conclusions:
- The partial occlusion clamp site is a common origin for type A aortic dissection after CABG.
- This complication is associated with considerable morbidity and mortality.
- The potential for increased risk of iatrogenic dissections with off-pump coronary artery bypass (OPCAB) using partial occlusion clamps warrants further investigation.