Type-A Aortic Dissection after Non-Aortic Cardiac Surgery
Background—Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occasionally leads to Type-A aortic dissection (AAD).
Methods and Results—103 patients with surgical repair for AAD following non-aortic cardiac surgery were identified. Using logistic regression modelling, coronary artery bypass surgery (CABG), either isolated or combined with another procedure in the initial operation, was associated with significantly higher operative mortality as compared to patients with non-CABG procedures at the time of AAD repair both for all patients (OR 2.90; 95%CI 1.09-7.72; P=0.033) and for patients with acute and chronic AAD ≥30-days after the initial operation (OR 3.62; 95%CI 1.13-11.54, P=0.03). In patients who developed AAD late after the initial operation, operative mortality was highest in patients without preoperative coronary angiography and appropriate management of their native coronary artery disease (CAD) and graft disease (OR 5.36; 95%CI 1.68-17.0; P=0.002). Nearly all the intimal dissection tears were located at sites of previous surgical trauma. Most of the ascending aortas that had dissected initially had a diameter ≥40 mm with histological evidence of medial degeneration in resected tissue samples.
Conclusions—In patients who have undergone prior cardiac surgery, pre-existing aortic wall pathology contributes to AAD with typical intimal damage at sites of mechanical trauma. The operative mortality was the highest in patients with prior CABG as compared to patients with non-CABG procedures. Preoperative coronary angiography and operative management of native coronary and graft disease were significantly associated with outcome in patients with prior CABG.
- Received March 14, 2013.
- Revision received July 24, 2013.
- Accepted August 9, 2013.