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Perioperative type I aortic dissection during conventional coronary artery bypass surgery: risk factors and

Bulend Ketenci1, Yavuz Enc, Batuhan Ozay

  • 1Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Istanbul, Turkey. bulendketenci@gmail.com

The Heart Surgery Forum
|September 11, 2008
PubMed

Insights

Perioperative iatrogenic type I aortic dissection (PIAD) is a rare complication of coronary artery bypass surgery. Risk factors include female sex, hypertension, peripheral arterial disease, wider aortic diameter, and high cardiopulmonary bypass pressure.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Perioperative iatrogenic type I aortic dissection (PIAD) is a rare but potentially fatal complication of conventional coronary artery bypass surgery (CCABG).
  • Prompt recognition and repair of PIAD are crucial for improving patient outcomes.

Purpose of the Study:

  • To identify risk factors and outcomes associated with PIAD following CCABG.
  • To compare characteristics of patients with PIAD to a control group without PIAD.

Main Methods:

  • Retrospective review of hospital records for patients undergoing CCABG between January 2001 and June 2007.
  • Identified 21 patients with PIAD (0.20%) out of 10,130 CCABG procedures.
  • Compared demographic, clinical, and intraoperative variables between PIAD patients and a control group (n=603).

Main Results:

  • PIAD occurred intraoperatively in 90% of cases, often after aortic crossclamp removal.
  • Significant differences between PIAD and control groups included sex (P=.05), history of hypertension (P=.001), and peripheral arterial disease (PAD) (P=.001).
  • Wider aortic diameter (P=.019) and high cardiopulmonary bypass pressure (P=.0001) were associated with PIAD. Mortality was high (33.3% preoperatively, 14.2% postoperatively).

Conclusions:

  • PIAD following CCABG is associated with a high mortality rate.
  • Identified risk factors for PIAD include female sex, history of PAD and hypertension, increased aortic diameter, and high cardiopulmonary bypass pressure.
  • Early detection and management are critical for improving survival rates in patients experiencing PIAD.
Abstract

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