Immediate Recognition and Surgical Treatment of Iatrogenic Acute Type A Aortic Dissection Is Associated with Low Hospital Mortality and High Intermediate-Term Survival.

BACKGROUND

To investigate short- and intermediate-term outcomes of immediate (on table) recognition and surgical treatment of iatrogenic acute type A aortic dissection (ATAD) that occurred during the course of the cardiac surgical procedures.

METHODS

Of 23,143 adult patients undergoing cardiac surgical procedures at our institution from January 2016 to December 2020, 21 (0.09%) suffered from intraoperative iatrogenic ATAD and underwent immediate aortic repair. Their clinical characteristics, in-hospital outcomes and follow-up results were analyzed.

RESULTS

Among the 21 patients, 13 (61.9%) suffered from hypertension, and 14 (66.7%) had a dilated ascending aorta. In-hospital mortality was 9.5%, and new onset of permanent neurologic deficit was recorded in one patient. During a median follow-up of 36.0 months, all 18 follow-up patients survived without repeated surgeries. A follow-up computed tomography (CT) examination revealed a residual false lumen in the aortic arch in 3 patients and in the descending aorta in 8, with residual false lumen perfusion in one.

CONCLUSIONS

Immediate recognition and surgical repair of ATAD that developed as a complication during cardiac surgical procedures are associated with low mortality and high intermediate-term survival.