Titre
Acute ascending aortic dissection complicating open heart surgery: cerebral perfusion defines the outcome
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Ruchat, P.
Auteure/Auteur
Hurni, M.
Auteure/Auteur
Stumpe, F.
Auteure/Auteur
Fischer, A. P.
Auteure/Auteur
von Segesser, L. K.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1010-7940
Statut éditorial
Publié
Date de publication
1998-11
Volume
14
Numéro
5
Première page
449
Dernière page/numéro d’article
52
Notes
Journal Article --- Old month value: Nov
Résumé
OBJECTIVE: This retrospective study was designed to assess the risks of acute ascending aorta dissection (AAD) as a rare but potentially fatal complication of open heart surgery. METHOD: Among 8624 cardiac surgical procedures under cardiopulmonary bypass (CPB) and cardioplegic myocardial protection from 1978 to 1997, 10 patients (0.12%) presented with a secondary or so called 'iatrogenic' AAD. There were seven men and three women, mean age 64 +/- 9 years, ranging from 47 to 79. The original procedures involved five coronary artery bypass grafts (CABG), one repeat CABG, one aortic valve replacement (AVR), one AVR and CABG, one mitral valvuloplasty (MVP) and CABG and one ascending aorta replacement. We retrospectively analyzed their hospital records. RESULTS: Group I consisted of seven patients with AAD intraoperatively and group II consisted of three patients who developed acute AAD 8-32 days after cardiac surgery. In group I, treatment consisted of the original procedure, plus grafting of the ascending aorta in six patients and closed plication and aortic wrapping in one. In group II, two patients received a dacron graft and one patient developed lethal tamponnade due to aortic rupture before surgery. Postoperatively, six patients responded well and three died (33%), two patients from group I on the 2nd postoperative day with severe post-anoxic encephalopathy, and one from group II with severe peroperative cardiogenic shock. CONCLUSION: Preventing AAD with the appropriate means remains standard practice in cardiac surgery. If AAD occurs, it requires prompt diagnosis and interposition graft to allow a better prognosis. Intraoperative AAD happens at the beginning of CPB jeopardizing perfusion of the supra-aortic arteries.
Sujets
PID Serval
serval:BIB_A20505AF74BC
PMID
Open Access
Oui
Date de création
2008-01-28T08:39:25.283Z
Date de création dans IRIS
2025-05-20T22:14:29Z
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Nom
REF.pdf
Version du manuscrit
published
Taille
41.65 KB
Format
Adobe PDF
PID Serval
serval:BIB_A20505AF74BC.P001
URN
urn:nbn:ch:serval-BIB_A20505AF74BC3
Somme de contrôle
(MD5):f31828f210caffcac40340403bc19325