Early postoperative aortic rupture following surgery for acute type A aortic dissection

We report our experience with patients who died of early aortic rupture following surgical treatment for acute type A aortic dissection in a consecutive series of 324 patients who underwent surgery for this condition between 1991 and 2007. In-hospital mortality rate was 9.9% (32/324), and seven patients (two men, mean age, 67 years) died of postoperative aortic rupture. Rupture sites were the proximal aorta in two and distal aorta in five patients. Surgical procedures included ascending aorta replacement in six and ascending aorta plus aortic arch replacement in one. The common characteristics of the two patients with proximal aortic rupture were preoperative aortic insufficiency, intraoperative bleeding from the proximal stump, and high blood pressure before the rupture. In contrast, the distal aortic ruptures occurred in patients with uncomplicated postoperative courses, with three distal aortic ruptures occurring on the inpatient ward. The only common characteristic of the distal aortic ruptures was residual patent false lumen (80%, 4/5 patients), the other patient had a large pre-existing aneurysm in the descending thoracic aorta. Careful postoperative management, including strict blood pressure control, is especially important in patients with residual patent false lumen following surgery for acute type A aortic dissection.