PMID- 9860199
OWN - NLM
STAT- MEDLINE
DCOM- 19990225
LR  - 20221207
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 14
IP  - 5
DP  - 1998 Nov
TI  - Acute ascending aortic dissection complicating open heart surgery: cerebral 
      perfusion defines the outcome.
PG  - 449-52
AB  - OBJECTIVE: This retrospective study was designed to assess the risks of acute 
      ascending aorta dissection (AAD) as a rare but potentially fatal complication of 
      open heart surgery. METHOD: Among 8624 cardiac surgical procedures under 
      cardiopulmonary bypass (CPB) and cardioplegic myocardial protection from 1978 to 
      1997, 10 patients (0.12%) presented with a secondary or so called 'iatrogenic' 
      AAD. There were seven men and three women, mean age 64 +/- 9 years, ranging from 
      47 to 79. The original procedures involved five coronary artery bypass grafts 
      (CABG), one repeat CABG, one aortic valve replacement (AVR), one AVR and CABG, 
      one mitral valvuloplasty (MVP) and CABG and one ascending aorta replacement. We 
      retrospectively analyzed their hospital records. RESULTS: Group I consisted of 
      seven patients with AAD intraoperatively and group II consisted of three patients 
      who developed acute AAD 8-32 days after cardiac surgery. In group I, treatment 
      consisted of the original procedure, plus grafting of the ascending aorta in six 
      patients and closed plication and aortic wrapping in one. In group II, two 
      patients received a dacron graft and one patient developed lethal tamponnade due 
      to aortic rupture before surgery. Postoperatively, six patients responded well 
      and three died (33%), two patients from group I on the 2nd postoperative day with 
      severe post-anoxic encephalopathy, and one from group II with severe peroperative 
      cardiogenic shock. CONCLUSION: Preventing AAD with the appropriate means remains 
      standard practice in cardiac surgery. If AAD occurs, it requires prompt diagnosis 
      and interposition graft to allow a better prognosis. Intraoperative AAD happens 
      at the beginning of CPB jeopardizing perfusion of the supra-aortic arteries.
FAU - Ruchat, P
AU  - Ruchat P
AD  - Department of Cardiovascular Surgery, University Hospital Center, Lausanne, 
      Switzerland. patrick.ruchat@chuv.hospvd.ch
FAU - Hurni, M
AU  - Hurni M
FAU - Stumpe, F
AU  - Stumpe F
FAU - Fischer, A P
AU  - Fischer AP
FAU - von Segesser, L K
AU  - von Segesser LK
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aortic Dissection/epidemiology/*etiology/surgery
MH  - Aorta/injuries/surgery
MH  - Aortic Aneurysm/epidemiology/*etiology/surgery
MH  - Blood Vessel Prosthesis Implantation
MH  - *Cardiac Surgical Procedures
MH  - Cardiopulmonary Bypass
MH  - Case-Control Studies
MH  - Cerebrovascular Circulation/*physiology
MH  - Female
MH  - Heart Arrest, Induced
MH  - Humans
MH  - Intraoperative Care
MH  - Intraoperative Complications/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Perfusion
MH  - Postoperative Complications/*epidemiology
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 1998/12/22 00:00
MHDA- 1998/12/22 00:01
CRDT- 1998/12/22 00:00
PHST- 1998/12/22 00:00 [pubmed]
PHST- 1998/12/22 00:01 [medline]
PHST- 1998/12/22 00:00 [entrez]
AID - S1010794098002243 [pii]
AID - 10.1016/s1010-7940(98)00224-3 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 1998 Nov;14(5):449-52. doi: 
      10.1016/s1010-7940(98)00224-3.