EACTS Expert Consensus Document on Iatrogenic Aortic Dissection

Iatrogenic aortic dissection (IAD) is a rare but life-threatening complication of open cardiac surgical procedures and catheter-based interventions, associated with high morbidity and mortality. With an ageing population and increasing procedural complexity, the absolute burden of IAD is expected to rise. Unlike spontaneous aortic dissection, IAD typically results from direct intimal injury during cannulation, clamping, catheter manipulation, or device deployment-while its clinical course is strongly influenced by the procedural context and the speed of recognition. Evidence to guide the management of IAD remains limited and is largely derived from registries and observational reports, contributing to substantial variation in diagnostic and therapeutic strategies. This European Association for Cardio-Thoracic Surgery Expert Consensus Document provides the first dedicated, multidisciplinary guidance on IAD, covering definitions and classification, risk factors, prevention, early diagnosis, acute management pathways, and post-discharge surveillance. The document synthesizes available evidence in the literature and expert opinions to offer practical, procedure-specific guidance and algorithms for IAD treatment. The guidance and algorithms include recommendations for rapid identification, containment, and timely surgical or endovascular repair of IAD, as well as conservative management strategies when appropriate, with the aim of supporting clinical decision-making and ultimately improving patient outcomes.