Iatrogenic Acute Type A Aortic Dissection Occurring during Elective Cardiac Surgery versus Catheter-Based Interventions: A Retrospective Analysis

Objectives: Iatrogenic acute type A aortic dissection (iATAAD) is a relatively uncommon but potentially life-threatening complication of invasive diagnostic or therapeutic procedures in interventional cardiology and cardiac surgery. Poor literature is available and describes mostly small case series. Aim of this study is to analyze differences between two different etiologies of iATAAD from a single-center experience.

Methods: A total of 108 patients who underwent surgery for iATAAD from January 2000 to December 2019 were selected from the local retrospective ATAAD database. The cohort was divided into two groups, according to iatrogenic dissection etiology: elective cardiac surgery (ECS; N = 31) versus catheter-based interventions (CBI: cardiac catheterization, endovascular aortic repair, TAVI; N = 77). t-test was performed to investigate differences between the groups.

Result: Patients developing iATAAD during ECS were older (72 ± 7.6 vs. 68 ± 11.2 years, p = 0.067), but showed no significant differences in preoperative clinical status except for chronic kidney insufficiency (ECS: 39%, CBI: 17%, p = 0.018). Operative times were significantly longer in the ECS group, where surgery was performed at a lower mean core temperature (22.5 ± 8.1 vs. 27.2 ± 8.4°C, p = 0.009), due to a preference in deep hypothermic cerebral protection strategies (deep hypothermic circulatory arrest or retrograde selective cerebral perfusion 87% vs 69%, p = 0.019). Aortic root underwent surgical repair more frequently in the CBI group (87 vs. 55%, p < 0.001) and was replaced more often (23 vs. 12%, p = 0.274). Postoperative course was similar between the groups in terms of cardiac function and neurological outcome. Hospitalization was longer for the ECS patients (15.1 ± 21.2 vs. 9.5 ± 8.7 days, p = 0.053), but survival rates were comparable (1 year survival 65 vs. 66%, p = 0.866).

Conclusion: This analysis confirms that iATAAD still represents a surgical challenge, with high morbidity and mortality rates. Acute aortic dissections occurring during ECS come with longer operative times as well as more extensive surgery, but postoperative course and survival rates are similar to those induced by CBI.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021