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Updated: Aug 22, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
[Type A dissection caused by aortic cannulation during coronary artery bypass grafting; report of a case]
Yoshihiro Nakayama1, N Minematsu, K Koga
1Department of Cardiovascular Surgery, Ohsumikanoya Hospital, Kanoya, Japan.
Insights
Aortic dissection occurred during coronary artery bypass grafting (CABG) due to cannulation. Prompt diagnosis and surgical repair of the ascending aorta, followed by completion of the CABG, ensured an uneventful recovery.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- A 71-year-old female patient presented with severe stenosis in the left anterior descending coronary artery origin and a large diagonal branch.
- The patient was scheduled for coronary artery bypass grafting (CABG).
Observation:
- During aortic cannulation for CABG, the ascending aorta exhibited a bluish discoloration.
- Epiaortic ultrasonography confirmed aortic dissection originating at the cannulation site.
Findings:
- Ascending aorta replacement was performed under deep hypothermia with circulatory arrest.
- The intimal tear was identified precisely at the aortic cannulation site.
- The planned coronary artery bypass grafting (left internal thoracic artery to LAD, saphenous vein graft to diagonal branch) was successfully completed, with the vein graft anastomosed to the aortic graft.
Implications:
- Rapid identification of aortic dissection during cardiac surgery is crucial.
- Timely and appropriate surgical management, including aortic repair and completion of revascularization, is essential.
- This case highlights the importance of vigilance for iatrogenic aortic injury and the successful management thereof.
Abstract:
A 71-year-old woman who had severe stenosis in the origin of the left anterior descending coronary artery with large diagonal branch was scheduled for coronary artery bypass grafting (CABG). After harvesting of bypass conduits, aortic cannulation was performed into the ascending aorta. Immediately after insertion of the cannula, however, the ascending aorta changed to a bluish color. Epiaortic ultrasonography revealed aortic dissection. Replacement of the ascending aorta was carried out using circulatory arrest under deep hypothermia. The intimal tear was located at the cannulation site. After this procedure, scheduled CABG the left internal thoracic artery to the left anterior descending coronary artery and the saphenous vein graft to the diagonal branch was performed. The proximal site of the saphenous vein graft was anastomosed to the replaced graft. The postoperative course was uneventful. Rapid identification and appropriate surgical management are necessary to minimize patient morbidity and mortality.
