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Iatrogenic Type A Dissection: Case Series and Surgical Management From a High-Volume Aortic Center

Amit Iyengar1,2, John J Kelly1,2, Michael Catalano1,2

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Annals of Thoracic Surgery Short Reports
|January 10, 2025
PubMed

Insights

Iatrogenic type A aortic dissection is a rare but serious complication of cardiac procedures. Surgical repair has high in-hospital mortality, but a specific repair strategy can ensure long-term durability.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Interventional Cardiology

Background:

  • Iatrogenic type A aortic dissection is a rare complication of cardiac procedures.
  • It is associated with significant morbidity and mortality.
  • Understanding its incidence and outcomes is crucial for patient care.

Purpose of the Study:

  • To determine the intraoperative incidence of iatrogenic type A aortic dissection.
  • To describe the surgical management strategies employed.
  • To evaluate the outcomes of patients undergoing repair for this condition.

Main Methods:

  • Retrospective review of adult cardiac surgery database (2002-2018).
  • Identification of patients with iatrogenic type A aortic dissection repairs.
  • Analysis of operative reports for causes and repair strategies, with follow-up for mortality and reintervention.

Main Results:

  • 36 patients identified with iatrogenic type A aortic dissection (0.1% incidence).
  • Dissections arose from open surgery (63.9%), PCI (13.9%), TEVAR (13.9%), and other endovascular procedures (8.3%).
  • In-hospital mortality was 36.1%; long-term survival was good, with limited need for reintervention (11.1% treated endovascularly).

Conclusions:

  • Iatrogenic type A dissections are rare but serious, carrying high mortality with surgical repair.
  • A repair strategy using an open distal anastomosis and proximal root reconstruction offers durable results.
  • This approach minimizes the need for subsequent aortic reoperations.
Abstract

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