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Ann Thorac Surg 2001;71:117-121
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery?

Olivier Chavanon, MDa, Michel Carrier, MDa, Raymond Cartier, MDa, Yves Hébert, MDa, Michel Pellerin, MDa, Pierre Pagé, MDa, Louis P. Perrault, MD, PhDa

a Department of Surgery, Research Center, Montreal Heart Institute, Montreal, Quebec, Canada

Accepted for publication May 9, 2000.

Address reprint requests to Dr Perrault, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec, Canada H1T 1C8
e-mail: lpperrau{at}icm.umontreal.ca

Background. An apparent increase in the incidence of acute ascending aortic dissection following off-pump coronary artery bypass grafting (OPCAB) led us to assess retrospectively the rate and circumstances of this complication in our institution on a consecutive series of patients undergoing aortocoronary bypass performed with and without extracorporeal circulation (ECC).

Methods. A retrospective analysis of acute ascending aortic dissections complicating coronary artery bypass grafting surgery in 3,031 patients in our institution since April 1, 1995, was performed using the database of the Montreal Heart Institute.

Results. There was a greater frequency of hypertension in the OPCAB group. Iatrogenic acute aortic dissection occurred in 3 patients among 308 operated on without ECC (0.97%) and 1 patient among 2,723 operated on under ECC (0.04%). This difference was statistically significant (p < 0.00001).

Conclusions. The risk of aortic dissection may be increased in OPCAB. Careful manipulation of the aorta with a single side-clamping and a control of the arterial pressure should be used to minimize aortic trauma. High-risk patients should undergo CABG without side-clamping of the aorta or CABG with ECC to prevent this redoubtable complication of myocardial revascularization.




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