Aortic posterior wall perforation with automatic aortic cutter during routine off-pump coronary bypass grafting
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Published on: September 15, 2023
Thomas Syburra1, Oliver Reuthebuch, Kirk Graves
1Division of Cardiac Surgery, City Hospital Triemli, Zurich, Switzerland. thomas.syburra@triemli.stzh.ch
Insights
A rare aortic perforation occurred during off-pump coronary artery bypass grafting using an automatic aortic cutter. This complication led to massive bleeding, requiring emergency surgery and aortic valve replacement.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Minimally Invasive Cardiac Surgery
Background:
- Off-pump coronary artery bypass grafting (OPCAB) aims to reduce complications associated with cardiopulmonary bypass.
- Aortic manipulation during OPCAB, particularly for proximal anastomoses, carries inherent risks.
- Minimizing aortic cross-clamping is a key goal in OPCAB procedures.
Observation:
- A posterior aortic wall perforation occurred during routine OPCAB.
- The complication arose after using an automatic aortic cutter to create a hole in the ascending aorta.
- This perforation resulted in massive intraoperative hemorrhage.
Findings:
- The aortic perforation necessitated immediate conversion to cardiopulmonary bypass.
- Emergency surgical intervention included replacement of the aortic valve and ascending aorta.
- This case highlights a rare but severe complication of automated aortic cutting devices.
Implications:
- Enhanced safety protocols and device selection are crucial for OPCAB procedures.
- Surgeons must be prepared for rare but catastrophic aortic complications during OPCAB.
- Further research into safer methods for proximal anastomosis in OPCAB is warranted.
Abstract:
Aortic complications are very rare during off-pump coronary artery bypass grafting (OPCAB). When they occur, the mortality is high. We report a case of perforation of the posterior aortic wall after punching out the hole in the ascending aorta with an automatic aortic cutter to avoid clamping for the proximal anastomosis during a routine OPCAB procedure. The consequence was a massive hemorrhage, emergency conversion to cardiopulmonary bypass and replacement of the aortic valve and of the ascending aorta.
