HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Peter Oberwalder Igor Knez Bruno Rigler Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stanger, O. Articles by Rigler, B. Search for Related Content PubMed PubMed Citation Articles by Stanger, O. Articles by Rigler, B. Related Collections Great vessels

Eur J Cardiothorac Surg 2002;21:453-458
© 2002 Elsevier Science NL

Late dissection of the ascending aorta after previous cardiac surgery: risk, presentation and outcome

Division of Cardiac Surgery, Department of Cardiac Surgery, Karl-Franzens University School of Medicine, Auenbruggerplatz 29, A-8036 Graz, Austria

Received 5 October 2001; received in revised form 3 December 2001; accepted 5 December 2001.

* Corresponding author. Tel.: +43-662-44820; fax: +43-662-828318
e-mail: olaf.stanger{at}kfunigraz.ac.at

Objective: Aortic dissection is a potentially life-threatening condition and may follow surgical interventions as a complication with distinct presentation and high mortality. Information on the incidence and etiology of aortic dissections following cardiac surgery is sparse and inconsistent. The true incidence of this entity may so far have been underestimated. Methods: Data of 223 operations on the thoracic aorta performed exclusively at our institution between January 1990 and May 2001 were analysed for clinical and prognostic features. Patients with Marfan syndrome and traumatic cases were not included. Cases of type A aortic dissection following cardiac surgery were investigated further. Results: Dissection of the ascending aorta occurred in 83 patients, of whom 11 (13.2%, six acute and five chronic) had undergone previous cardiac surgery (four aortic valve replacements (AVR), two double valve replacements (DVR), two AVR+coronary artery bypass grafts (CABG), three CABGs). The time interval between first operation and dissection was 0.2–17 years (median 3.3 years). Eight (72%) patients had arterial hypertension. The aortic diameter was 50 mm in all 11 cases upon presentation. Dissections were treated with Bentall procedures (3), Cabrol procedure (1), supracoronary tube graft (6) including concomitant CABG (3) and AVR with local repair (1). Total in-hospital mortality was 54% (6/11), and 66% (4/6) in cases with acute dissection due to low cardiac output (3) and myocardial infarction (3). Conclusions: Type-A aortic dissection can follow cardiac operations at any time with no typical interval or associated histology and with high overall hospital mortality. Male patients with arterial hypertension are at increased risk. Clinical presentation may differ from primary dissection with implications for management and risk estimation.

Key Words: Aortic dissection • Valve replacement • Coronary artery bypass surgery

This article has been cited by other articles:

				T. Syburra, O. Reuthebuch, K. Graves, and M. Genoni Aortic posterior wall perforation with automatic aortic cutter during routine off-pump coronary bypass grafting Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 840 - 841. [Abstract] [Full Text] [PDF]

				A. Weber, R. Tavakoli, J. Gruenenfelder, and M. Genoni Ascending aortic dissection after proximal bypass anastomotic device. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1364 - 1365. [Full Text] [PDF]

				Z. Masuda, T. Murakami, E. Shishido, and M. Kuinose A Rare Cause of Dissection of Ascending Aorta after Aortic Valve Replacement Asian Cardiovasc Thorac Ann, February 1, 2008; 16(1): e4 - e6. [Abstract] [Full Text] [PDF]

				M. Zinkernagel, M. J. Wilhelm, R. Tavakoli, M. I. Turina, and M. Genoni Aortic Dissection With Potential Origin From a Mechanical Bypass Anastomosis Ann. Thorac. Surg., July 1, 2005; 80(1): 316 - 318. [Abstract] [Full Text] [PDF]

				S. Trimarchi, C. A. Nienaber, V. Rampoldi, T. Myrmel, T. Suzuki, R. H. Mehta, E. Bossone, J. V. Cooper, D. E. Smith, L. Menicanti, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 112 - 122. [Abstract] [Full Text] [PDF]

				H. Hirose, L. G. Svensson, B. W. Lytle, E. H. Blackstone, J. Rajeswaran, and D. M. Cosgrove Aortic Dissection After Previous Cardiovascular Surgery Ann. Thorac. Surg., December 1, 2004; 78(6): 2099 - 2105. [Abstract] [Full Text] [PDF]

				J. S. Collins, A. Evangelista, C. A. Nienaber, E. Bossone, J. Fang, J. V. Cooper, D. E. Smith, P. T. O'Gara, T. Myrmel, D. Gilon, et al. Differences in Clinical Presentation, Management, and Outcomes of Acute Type A Aortic Dissection in Patients With and Without Previous Cardiac Surgery Circulation, September 14, 2004; 110(11_suppl_1): II-237 - II-242. [Abstract] [Full Text] [PDF]