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Robert J. Still
Cary W. Akins
Willard M. Daggett
Mortimer J. Buckley
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Ann Thorac Surg 1992;53:374-380
© 1992 The Society of Thoracic Surgeons

Articles

Intraoperative aortic dissection

Robert J. Still, MD1, Alan D. Hilgenberg, MD*, Cary W. Akins, MD, Willard M. Daggett, MD, Mortimer J. Buckley, MD

Surgical Cardiovascular Unit, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts USA

* Address reprint requests to Dr Hilgenberg, Surgical Cardiovascular Unit, Massachusetts General Hospital, 32 Fruit St, Boston, MA 02114 USA.

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 1900 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. Prompt recognition and repair are necessary to limit the extent of dissection and minimize patient morbidity and mortality.




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