Abstract
Introduction
Late ascending aortic dissection after coronary artery bypass grafting (CABG) is an uncommon phenomenon, and treatment presents a complex clinical dilemma.
Materials and methods
Between 1995 and 2005, eight patients were diagnosed with post-CABG late acute aortic dissection. Mean age was 61.7 (range 52–76), and mean period between CABG and late acute aortic dissection was 45.3 months (range 5 to 122 months). Three patients underwent surgical replacement of the ascending aorta. One patient died after surgery, and the other two had an uneventful recovery, with a successful mean 6.5-year follow-up. Five patients were treated conservatively, with a mean follow-up of 81.2 months (range 50–112 months).
Results and discussion
Periodic computed tomography (CT) scans showed minor or no change in aortic diameter and satisfactory general condition. Late acute aortic dissection after CABG is rare. Only a few reports have been published, and no standard treatment guidelines exist.
Conclusion
We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection and therefore suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial.
Condensed abstract
Late ascending aortic dissection after CABG is rare, and treatment presents a clinical dilemma. We treated eight patients with post-CABG late acute aortic dissection. Three underwent surgical replacement of the ascending aorta. One died after surgery, and the other two had an uneventful recovery. Five patients were treated conservatively. No standard treatment guidelines exist for late acute aortic dissection after CABG. We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection, and suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial.
Similar content being viewed by others
References
Litchford B, Okies JE, Sugimura S, Starr A (1976) Acute aortic dissection from cross-clamp injury. J Thorac Cardiovasc Surg 72:709–713
Boruchow IB, Iyengar R, Jude JR (1977) Injury to ascending aorta by partial-occlusion during aorta-coronary bypass. J Thorac Cardiovasc Surg 73:303–305
Nicholson WJ (1978) Aortic root dissection complicating coronary bypass surgery. Am J Cardiol 41:103–107
Bopp P, Perrenoud JJ, Periat M (1981) Dissection of ascending aorta. Rare complication of aortocoronary venous bypass surgery. Br Heart J 46:571–573
Gillinov AM, Lytle BW, Kaplon RJ, Casselman FP, Blackstone EH, Cosgrove DM (1999) Dissection of the ascending aorta after previous cardiac surgery: differences in presentation and management. J Thorac Cardiovasc Surg 117:252–260
Stanger O, Oberwalder P, Dacar D, Knez I, Rigler B (2002) Late dissection of the ascending aorta after previous cardiac surgery: risk, presentation and outcome. Eur J Cardiothorac Surg 21:453–458
Westaby S (1995) Management of aortic dissection. Curr Opin Cardiol 10:505–510
Epperlein S, Mohr-Kahaly S, Erbel R, Kearney P, Meyer J (1994) Aorta and aortic valve morphologies predisposing to aortic dissection. An in vivo assessment with transoesophageal echocardiography. Eur Heart J 15:1520–1527
Larson EW, Edwards WD (1984) Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 53:849–855
Russo CF, Mazzetti S, Garatti A, Ribera E, Milazzo A, Bruschi G, Lanfranconi M, Colombo T, Vitali E (2002) Aortic complications after bicuspid aortic valve replacement: long-term results. Ann Thorac Surg 74:S1773–S1776 discussion S1792–9
Bayegan K, Domanovits H, Schillinger M, Ehrlich M, Sodeck G, Laggner AN (2001) Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade. Eur J Cardiothorac Surg 20:1194–1198
DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr (1965) Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 49:130–149
Appelbaum A, Karp RB, Kirklin JW (1976) Ascending vs descending aortic dissections. Ann Surg 183:296–300
Masuda Y, Yamada Z, Morooka N, Watanabe S, Inagaki Y (1991) Prognosis of patients with medically treated aortic dissections. Circulation 84(5 Suppl):III7–III13
Miller DC (1989) Acute aortic dissection: current management guidelines. J Jap Coll Angiol 29:837–840
Glower DD, Fann JI, Speier RH, Morrison L, White WD, Smith LR, Rankin JS, Miller DC, Wolfe WG (1990) Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation 82(5 Suppl):IV39–IV46
Westaby S, Saito S, Katsumata T (2002) Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg 73:707–713
Shingu Y, Myojin K, Ishibashi Y, Ishii K, Kawasaki M, Ijima K (2003) Is conservative therapy acceptable for thrombosed type A acute aortic dissection? Jpn J Thorac Cardiovasc Surg 51:496–499
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shinfeld, A., Raanani, E. Late acute aortic dissection after coronary artery bypass. Langenbecks Arch Surg 394, 345–348 (2009). https://doi.org/10.1007/s00423-008-0305-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0305-7