Acute aortic dissection during minimally invasive cardiac surgery: a case report

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiac Anesthesia

Background:

• Acute aortic dissection (AAD) is a rare but serious complication during minimally invasive cardiac surgery (MICS).
• Retrograde perfusion via femoral artery during cardiopulmonary bypass (CPB) is a potential risk factor for AAD.
• Management strategies for MICS-associated AAD are not well-established.

Purpose of the Study:

• To present a successful management of AAD that occurred during the late CPB phase in MICS.
• To highlight the importance of continuous monitoring and early detection of AAD during MICS.

Main Methods:

• A 63-year-old male underwent totally endoscopic aortic valve replacement.
• CPB was initiated via right femoral artery cannulation.
• Transesophageal echocardiography detected type A AAD during CPB, leading to ascending aortic replacement under deep hypothermic circulatory arrest without altering cannulation strategy.

Main Results:

• Successful management of type A AAD during MICS.
• Ascending aortic replacement performed without changing the established CPB route.
• Preservation of cerebral perfusion throughout the event.

Conclusions:

• Continuous monitoring during CPB in MICS is essential for timely AAD detection.
• Early diagnosis and prompt intervention can lead to successful surgical outcomes.
• Vascular graft replacement is a viable option for managing MICS-associated AAD.