Short- and Long-Term Outcomes after Iatrogenic Type A Aortic Dissection

Objectives: Iatrogenic Type A aortic dissection (IAD) is a rare but serious complication during interventional or operative cardiac procedures with an incidence up to 0.2%. We demonstrate short- and long-term results of surgically treated patients with iatrogenic acute Type A aortic dissection.

Methods: Out of 587 patients operated for acute Type A aortic dissection between January 2004 and June 2017, 28 (4.8%) patients suffered from iatrogenic aortic dissection (IAD). Previous operative or interventional procedures were percutaneous coronary intervention (PCI, n = 14), transcatheter aortic valve replacement (TAVR, n = 2), thoracic endovascular aortic repair (TEVAR, n = 2), and cardiac surgery (n = 10). IAD patients were identified retrospectively and compared with patients operated for spontaneous acute Type A aortic dissection (n = 559).

Results: Mean age was significantly higher in the IAD group compared with the control group (71 ± 11 vs. 64 ± 14 years, p < 0.001). Incidence of diabetes (p = 0.04), hypertension (p = 0.015) and coronary artery disease (p < 0.001) were significantly higher in the IAD group. Preoperative resuscitation (CPR) rate was significantly higher in IAD group compared to the control group (21 vs. 6%, p < 0.001). CPB time was longer in the IAD group (194 ± 122 vs. 166 ± 81 minutes, p = 0.075) and more concomitant CABG procedures were performed (p < 0.001). Rethoracotomy rate was higher in the IAD group (p = 0.021) and ICU stay (p = 0.042) and ventilation times (p = 0.029) were significantly longer. In-hospital mortality rate was higher in the IAD group (17.9 vs. 10.7%, p = 0.242).

Ten-year survival rates in the IAD group were lower compared with the control group (42.5 vs. 57%, p = 0.068).

Conclusion: IAD is a dangerous complication during cardiac interventional or operative procedures and more frequent in older patients with a higher rate of preoperative resuscitation. Nevertheless, surgically managed short- and long-term results of IAD are comparable to spontaneous type A aortic dissection results. Consequent and early surgical therapy for aortic dissection including IAD remain the gold standard.

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