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The Annals of Thoracic Surgery, Vol 53, 374-379, Copyright © 1992 by The Society of Thoracic Surgeons
RJ Still, AD Hilgenberg, CW Akins, WM Daggett and MJ Buckley
Intraoperative aortic dissection is a rare but potentially fatal
complication of open heart operations. If the dissection is promptly
recognized and repaired, however, the outcome may be significantly better.
In this study, we reviewed the hospital records of patients with dissection
of the aortic arch occurring as a complication of a cardiac operation at
Massachusetts General Hospital and Mt. Auburn Hospital from January 1980
through June 1990. During this period, 14,877 surgical procedures with the
use of cardiopulmonary bypass and aortic cannulation were performed, and 24
patients (0.16%) with iatrogenic aortic dissection were identified.
Dissection was discovered intraoperatively in 20 patients and
postoperatively after complications developed in 4. Of the 20 patients
whose injuries were discovered intraoperatively and repaired, 4 (20%) died.
Of the 4 whose injuries were discovered after operation, 2 (50%) died. The
primary cause of death was ventricular dysfunction resulting from
myocardial ischemia. Dissections originated at the aortic cannulation site
in 10 patients, at the cross-clamp site in 8, at the site of the
partial-occlusion clamp in 7, at the proximal anastomosis in 1 patient, and
as a result of direct injury in 1. Three of these patients had simultaneous
injuries at the aortic cannulation site and at the heel of the partial-
occlusion clamp. Two techniques of repair were used: primary repair and
patch or tube graft insertion. There were two deaths in the patients who
underwent primary repair and four deaths in patients requiring graft
replacement. Although it is uncommon, intraoperative aortic dissection can
be a lethal complication of cardiac operations.(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Intraoperative aortic dissection
Surgical Cardiovascular Unit, Massachusetts General Hospital, Boston 02114.
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