Type A aortic dissection after Coronary Artery Bypass Grafting

Area of Science:

• Cardiovascular Surgery
• Aortic Surgery
• Cardiac Anesthesia

Background:

• Aortic dissection is a rare but life-threatening complication following coronary artery bypass grafting (CABG).
• Reoperation for aortic dissection post-CABG presents challenges including adhesions and myocardial protection.
• No established treatment guidelines exist for chronic aortic dissection after CABG.

Observation:

• A 65-year-old female with hypertension, diabetes, and hyperlipidemia developed chronic type A aortic dissection three years after CABG.
• Contrast-enhanced CT revealed dissection extending from the sinotubular junction to below the brachiocephalic trunk.
• The patient presented with progressive chest pain.

Findings:

• Successful surgical repair was achieved using peripheral cannulation (right femoral artery and vein) for cardiopulmonary support.
• An intimal tear was identified near the anastomosis of saphenous vein grafts.
• Del-Nido cardioplegia facilitated uninterrupted surgical time for complex aortic repair and bypass grafting.

Implications:

• Peripheral cannulation offers a secure and bloodless re-entry sternotomy in reoperative cardiac surgery.
• Del-Nido cardioplegia is a safe and effective method for myocardial protection during complex aortic procedures.
• This case demonstrates a viable treatment strategy for chronic aortic dissection post-CABG.