1
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Ishida S, Takemoto Y, Kimata R, Yagami K. Iatrogenic acute type A aortic dissection during catheter ablation for idiopathic ventricular premature contraction. Oxf Med Case Reports 2024; 2024:omae110. [PMID: 39309707 PMCID: PMC11416712 DOI: 10.1093/omcr/omae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/17/2024] [Indexed: 09/25/2024] Open
Abstract
Acute aortic dissection type A during cardiac catheterization has been reported as a rare but fatal complication. We present a case of acute aortic dissection type A occurring during catheter manipulation in the ascending aorta during mapping of ventricular premature contraction via the retrograde approach. In the present case, transthoracic echocardiography showed no pericardial effusion and no flap of the aorta, but intracardiac echo clearly showed the flap. Enhanced computed tomography revealed the aortic dissection, which extended from the ascending aorta to the bilateral common iliac artery, and the false lumen was thrombosed completely. Emergent surgery was performed and the postoperative course was uneventful, and he was discharged with no complications. Aortic dissection is a rare complication of cardiac catheterization, and early detection could prevent a fatal outcome. It is important to detect the signs and symptoms as quickly as possible and perform various diagnostic examinations.
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Affiliation(s)
- Shinichi Ishida
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi-city, Gifu 507-8522, Japan
| | - Yoshio Takemoto
- Department of Cardiology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi-city, Gifu 507-8522, Japan
| | - Ryutaro Kimata
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi-city, Gifu 507-8522, Japan
| | - Kei Yagami
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi-city, Gifu 507-8522, Japan
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2
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Cavanaugh S, Amirjamshidi H, Hisamoto K. Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR). J Clin Med 2023; 12:7630. [PMID: 38137699 PMCID: PMC10744134 DOI: 10.3390/jcm12247630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication.
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Affiliation(s)
| | | | - Kazuhiro Hisamoto
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA; (S.C.)
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3
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Danushka PGN, Jayasinghe R, Munsinghe M. A late presentation of acute iatrogenic aortic dissection following percutaneous coronary intervention: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231211714. [PMID: 37954541 PMCID: PMC10638864 DOI: 10.1177/2050313x231211714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Acute iatrogenic aortic dissection following percutaneous coronary intervention is a rare but sinister cause of post-procedure morbidity and mortality. Delayed diagnosis increases the mortality significantly. We present a case of a 52-year-old male who presented with an iatrogenic aortic dissection following percutaneous coronary intervention for an inferior ST-elevation myocardial infarction. Although the diagnosis was initially missed by conventional imaging for a period of 5 months, it was later diagnosed assisted by cardiac computed tomography. The patient underwent aortic repair with a Dacron graft and had an uneventful recovery. The case highlights the importance of early diagnosis and selection of appropriate imaging for this rare but serious iatrogenic sequel following percutaneous coronary intervention to minimize morbidity.
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Affiliation(s)
- PGN Danushka
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - R Jayasinghe
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - M Munsinghe
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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4
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Kato K, Nakamura K, Kato K, Arai S, Hirooka S, Kim C, Uchino H, Shimanuki T. Iatrogenic aortic dissection during aortic root replacement in an older Loeys-Dietz syndrome type III patient with no family history of aortic disease: a case report. J Cardiothorac Surg 2023; 18:305. [PMID: 37936231 PMCID: PMC10631125 DOI: 10.1186/s13019-023-02430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/04/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Iatrogenic aortic dissection during cardiac surgery is a rare but critical complication. At present, no strategies have been developed to prevent it. We herein report a case of intraoperative aortic dissection during aortic root replacement in an older patient with Loeys-Dietz syndrome type III who had no family history of aortic disease. CASE PRESENTATION A 60-year-old man was admitted to the hospital for Stanford type B acute aortic dissection and given conservative treatment. He was found to have aortic root dilatation and severe aortic regurgitation. Thus, elective Bentall procedure was performed. Postoperative computed tomography showed new Stanford type A aortic dissection that may have developed due to aortic cannulation during surgery. The patient was given conservative treatment and successfully discharged to home at postoperative day 34. Although he had no family history of aortic disease, a genetic test revealed an unreported SMAD3 frameshift mutation (c.742_749dup, p. Gln252ThrfsTer7), and the patient was diagnosed with Loeys-Dietz syndrome type III. CONCLUSION In patients with connective tissue disorder, aortic manipulations may become the cause of critical complications. Avoiding the use of invasive techniques, such as cannulation and cross-clamping, and implementing treatment strategies, such as perfusion from other sites than the aorta and open distal anastomosis, can prevent these complications, and may be useful treatment modalities. The possibility of connective tissue disease should be considered even if the patient is older and has no family history of aortic disease.
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Affiliation(s)
- Kenichi Kato
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan.
| | - Ken Nakamura
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Kaho Kato
- Certified Genetic Counselor, Nihonkai General Hospital, Sakata, Japan
| | - Shusuke Arai
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Shuto Hirooka
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Cholsu Kim
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Hideaki Uchino
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Takao Shimanuki
- Division of Cardiovascular Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
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5
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Milojevic M, Milosevic G, Nikolic A, Petrovic M, Petrovic I, Bojic M, Jagodic S. Mastering the Best Practices: A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery. J Cardiovasc Dev Dis 2023; 10:296. [PMID: 37504552 PMCID: PMC10380276 DOI: 10.3390/jcdd10070296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.
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Affiliation(s)
- Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- Erasmus University Medical Center, Department of Cardiothoracic Surgery, 3015 GD Rotterdam, The Netherlands
| | - Goran Milosevic
- Department of Perfusion Technology, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Aleksandar Nikolic
- Department of Cardiac Surgery, Acibadem-Sistina Hospital, 1000 Skopje, North Macedonia
| | - Masa Petrovic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Petrovic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Milovan Bojic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Sinisa Jagodic
- Department of Perfusion Technology, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
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7
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Chung MM, Filtz K, Simpson M, Nemeth S, Kosuri Y, Kurlansky P, Patel V, Takayama H. Central aortic versus axillary artery cannulation for aortic arch surgery. JTCVS OPEN 2023; 14:14-25. [PMID: 37425444 PMCID: PMC10328800 DOI: 10.1016/j.xjon.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 07/11/2023]
Abstract
Objective Central aortic cannulation for aortic arch surgery has become more popular over the last decade; however, evidence comparing it with axillary artery cannulation remains equivocal. This study compares outcomes of patients who underwent axillary artery and central aortic cannulation for cardiopulmonary bypass during arch surgery. Methods A retrospective review of 764 patients who underwent aortic arch surgery at our institution between 2005 and 2020 was performed. The primary outcome was failure to achieve uneventful recovery, defined as having experienced at least 1 of the following: in-hospital mortality, stroke, transient ischemic attack, bleeding requiring reoperation, prolonged ventilation, renal failure, mediastinitis, surgical site infection, and pacemaker or implantable cardiac defibrillator implantation. Propensity score matching was used to account for baseline differences across groups. A subgroup analysis of patients undergoing surgery for aneurysmal disease was performed. Results Before matching, the aorta group had more urgent or emergency operations (P = .039), fewer root replacements (P < .001), and more aortic valve replacements (P < .001). After successful matching, there was no difference between the axillary and aorta groups in failure to achieve uneventful recovery, 33% versus 35% (P = .766), in-hospital mortality, 5.3% versus 5.3% (P = 1), or stroke, 8.3% versus 5.3% (P = .264). There were more surgical site infections in the axillary group, 4.8% versus 0.4% (P = .008). Similar results were seen in the aneurysm cohort with no differences in postoperative outcomes between groups. Conclusions Aortic cannulation has a safety profile similar to that of axillary arterial cannulation in aortic arch surgery.
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Affiliation(s)
- Megan M. Chung
- Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Kerry Filtz
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Michael Simpson
- Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Samantha Nemeth
- Center for Innovation and Outcomes Research, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Yaagnik Kosuri
- Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Virendra Patel
- Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
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8
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Biancari F, Pettinari M, Mariscalco G, Mustonen C, Nappi F, Buech J, Hagl C, Fiore A, Touma J, Dell’Aquila AM, Wisniewski K, Rukosujew A, Perrotti A, Hervé A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Rodriguez Lega J, Pinto AG, Mäkikallio T, Acharya M, El-Dean Z, Field M, Harky A, Gerelli S, Di Perna D, Jormalainen M, Gatti G, Mazzaro E, Juvonen T, Peterss S. Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection. J Clin Med 2022; 11:jcm11226729. [PMID: 36431205 PMCID: PMC9696328 DOI: 10.3390/jcm11226729] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p < 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.
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Affiliation(s)
- Fausto Biancari
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
- Correspondence:
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium
| | | | - Caius Mustonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80539 Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Joseph Touma
- Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
| | - Francesco Onorati
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
| | - Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Amer Harky
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | | | - Dario Di Perna
- Centre Hospitalier Annecy Genevois, 74370 Annecy, France
| | - Mikko Jormalainen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Tatu Juvonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
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9
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Acute Limb Ischemia Caused by Dissection following Percutaneous Coronary Intervention Using Right Radial Approach. Case Rep Cardiol 2022; 2022:4846603. [PMID: 36341322 PMCID: PMC9629956 DOI: 10.1155/2022/4846603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Iatrogenic aortic dissection is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Iatrogenic aortic dissection following PCI is rare with most cases reporting dissection originating within the coronary vessels with propagation into the ascending aorta. In this specific case, dissection was without coronary involvement, with dissection extending from the ascending aorta into the descending aorta and iliac vessels. Although PCI via radial approach is associated with fewer vascular complications than with femoral approach, significant adverse outcomes may still occur and require prompt intervention. This case highlights the highly atypical presentation of iatrogenic aortic dissection following cardiac catheterization presenting as acute limb ischemia. In such patients as with ours, immediate surgical intervention is necessary with overall poor prognosis.
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10
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Hisatomi K, Miura T, Obase K, Matsumaru I, Nakaji S, Tanigawa A, Taguchi S, Takura M, Nakao Y, Eishi K. Minimally Invasive Valvular Surgery in the Elderly - Safety, Early Recovery, and Long-Term Outcomes. Circ J 2022; 86:1725-1732. [PMID: 36198575 DOI: 10.1253/circj.cj-22-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND For elderly people, the benefit of minimally invasive cardiac surgery (MICS) is unclear, so we evaluated the safety, recovery, and long-term survival in elderly MICS patients. METHODS AND RESULTS 63 propensity score-matched pairs of 213 consecutive patients (≥70 years old) who underwent mitral and/or tricuspid valve surgery between 2010 and 2020 (121 right mini-thoracotomies vs. 92 full sternotomies) were compared. The primary outcome was safety (composite endpoint of in-hospital death or major complication). Secondary outcomes were early ambulation and discharge to home. There were no differences between the groups for in-hospital death (3.2% vs. 0.0%, P=0.157) and primary outcome (14.3% vs. 17.5%, P=0.617). The rate of early ambulation (73.0% vs. 55.6%, P=0.048) and discharge to home (66.7% vs. 49.2%, P=0.034) were significantly higher in the mini-thoracotomy group. Major complication was an independent negative predictor of early ambulation for mini-thoracotomy but not for a conservative approach. Survival was 87.8±4.4% vs. 86.8±4.7% at 5 years, which was not significantly different. CONCLUSIONS Similar safety but better recovery were observed for mini-thoracotomy, and long-term survival was comparable between groups. Major complication was a negative predictor of early ambulation after mini-thoracotomy. Careful preoperative risk stratification would enhance the benefits of MICS in elderly patients.
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Affiliation(s)
- Kazuki Hisatomi
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Kikuko Obase
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Ichiro Matsumaru
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Shun Nakaji
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Akihiko Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Shunsuke Taguchi
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Masayuki Takura
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Yuko Nakao
- Department of Cardiovascular Surgery, Nagasaki University Hospital
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital
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11
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von Aspern K, Leontyev S, Etz CD, Haunschild J, Misfeld M, Borger MA. Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective. AORTA (STAMFORD, CONN.) 2022; 10:201-209. [PMID: 36521814 PMCID: PMC9754867 DOI: 10.1055/s-0042-1756670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/06/2022] [Indexed: 06/17/2023]
Abstract
Iatrogenic aortic dissection (IAD) is a rare but devastating complication in cardiac surgery and related procedures. Due to its rarity, published data on emergency surgery following IAD are limited. Herein, we discuss IAD occurring intra- and postoperatively, including those occurring during transcatheter aortic valve replacement and cardiac catheterization, and present benchmark data from our consecutive, single-center experience. We demonstrate changes in patient characteristics, surgical approaches, and outcomes over a 23-year period.
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Affiliation(s)
- Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Sergey Leontyev
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Christian D. Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Cardiac Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia
| | - Michael A. Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
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12
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Song J, Qian J, Duan Q, Dong A, Kong M. The effect of in situ laser fenestration for total endovascular arch repair in redo aortic dissection. Vascular 2021; 30:1044-1050. [PMID: 34402656 DOI: 10.1177/17085381211041474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Treatment of aortic arch pathologies in redo cases is technically challenging. In this study, we assessed early and mid-term outcomes of total endovascular arch repair combined with a new method of in situ laser fenestration. METHODS Between January 2018 and March 2019, five patients with a history of cardiovascular surgery underwent in situ laser fenestration procedures using the "squid capture technique" for aortic arch pathologies with dissection. All patients were followed up regularly and imaging examinations were performed. The technical success, procedural complications, as well as the early and mid-term mortality and morbidity rates were evaluated. RESULTS All patients survived the operation and fenestration was technically successful in all of the patients. There was no in-hospital mortality. No patients developed major complications, such as peri-operative strokes, transient ischemic attacks, or spinal cord ischemia. The 11-22 months follow-up (mean, 17 months) was completed by all patients. No endoleaks were discovered; false lumen thromboses and subsequent positive remodeling of the aorta were demonstrated and all in situ laser-fenestrated arteries were patent. CONCLUSIONS In situ laser fenestration combined with "squid capture technique" was shown to may be an effective and safe option for reconstruction of aortic arch during thoracic endovascular aortic repair. In situ laser fenestration combined with "squid capture technology" was shown to be an effective treatment option for patients with prior history of cardiovascular surgery and who are at high risk for redo open operations.
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Affiliation(s)
- Jiangwei Song
- Department of Cardiovascular Surgery, Second Affiliated Hospital, 89681Zhejiang University, Hangzhou, People's Republic of China
| | - Jianfang Qian
- Department of Cardiovascular Surgery, Second Affiliated Hospital, 89681Zhejiang University, Hangzhou, People's Republic of China
| | - Qunjun Duan
- Department of Cardiovascular Surgery, Second Affiliated Hospital, 89681Zhejiang University, Hangzhou, People's Republic of China
| | - Aiqiang Dong
- Department of Cardiovascular Surgery, Second Affiliated Hospital, 89681Zhejiang University, Hangzhou, People's Republic of China
| | - Minjian Kong
- Department of Cardiovascular Surgery, Second Affiliated Hospital, 89681Zhejiang University, Hangzhou, People's Republic of China
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13
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Wahba A, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Puis L. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2021; 57:210-251. [PMID: 31576396 DOI: 10.1093/ejcts/ezz267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
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14
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Eshraghi A, Jalalyazdi M, Ramezani J, Baburian M. Late presentation of iatrogenic dissection of right coronary cusp: A case report. J Cardiovasc Thorac Res 2021; 12:341-344. [PMID: 33510886 PMCID: PMC7828762 DOI: 10.34172/jcvtr.2020.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 04/08/2020] [Indexed: 01/27/2023] Open
Abstract
Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation.
To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.
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Affiliation(s)
- Ali Eshraghi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Jalalyazdi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Ramezani
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Baburian
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Khachatryan Z, Leontyev S, Magomedov K, Haunschild J, Holzhey DM, Misfeld M, Etz CD, Borger MA. Management of aortic root in type A dissection: Bentall approach. J Card Surg 2020; 36:1779-1785. [PMID: 33345377 DOI: 10.1111/jocs.15271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We analyzed the results of the modified Bentall procedure in a high-risk group of patients presenting with acute type A aortic dissection (ATAAD). METHODS ATAAD patients undergoing a modified Bentall between 1996 and 2018 (n = 314) were analyzed. Mechanical composite conduits were used in 45%, and biological ones using either a bioprosthesis implanted into an aortic graft (33%) or xeno-/homograft root conduits (22%) in the rest. Preoperative malperfusion was present in 34% of patients and cardiopulmonary resuscitation required in 9%. RESULTS Concomitant arch procedures consisted of hemiarch in 56% and total arch/elephant trunk in 34%, while concomitant coronary artery surgery was required in 20%. The average cross-clamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 min, respectively, while the average circulatory arrest times were 29 ± 17 min. A total of 69 patients (22%) suffered permanent neurologic deficit, while myocardial infarction occurred in 18 cases (6%) and low cardiac output syndrome in 47 (15%). The in-hospital mortality rate was 17% due to intractable low cardiac output syndrome (n = 29), major brain injury (n = 16), multiorgan failure (n = 6), and sepsis (n = 2). The independent predictors of in-hospital mortality were critical preoperative state (odds ratio [OR], 5.6; p < .001), coronary malperfusion (OR, 3.6; p = .002), coronary artery disease (OR, 2.6; p = .033), and prior cerebrovascular accident (OR, 5.6; p = .002). CONCLUSIONS The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high-risk ATAAD patients presenting.
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Affiliation(s)
- Zara Khachatryan
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | | | - David M Holzhey
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
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16
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Omran T, Carr CS, Wani L, Mahmoud I, Taha R, Shoman B, Omar AS, Alkhulaifi AM. A tale of three pumps and a mechanical heart. SAGE Open Med Case Rep 2020; 8:2050313X20940543. [PMID: 32922790 PMCID: PMC7446551 DOI: 10.1177/2050313x20940543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Abstract
Temporary mechanical circulatory support device (tMCS) failure could qualify patients with advanced heart failure to receive a long-term solution. We report on a patient who presented with cardiorespiratory arrest that required a tMCS and developed acute type A aortic dissection. Data Sources: our case adds further evidence regarding the support of a patient with a second (or more) incidence of tMCS. This patient subsequently underwent left ventricular assist device insertion and type A aortic dissection repair, as a combined procedure, with a satisfactory outcome.
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Affiliation(s)
- Tarek Omran
- Departments of Cardiothoracic Surgery, Heart Hospital, Hamad medical corporation, Doha, Qatar
| | - Cornelia S Carr
- Departments of Cardiothoracic Surgery, Heart Hospital, Hamad medical corporation, Doha, Qatar
| | - Lateef Wani
- Departments of Cardiothoracic Surgery, Heart Hospital, Hamad medical corporation, Doha, Qatar
| | - Imad Mahmoud
- Department of Radiology, Heart Hospital, Hamad medical corporation, Doha, Qatar
| | - Rula Taha
- Anesthesia and Intensive care, Cardiothoracic surgery department, Heart Hospital, Doha, Qatar
| | - Bassam Shoman
- Anesthesia and Intensive care, Cardiothoracic surgery department, Heart Hospital, Doha, Qatar
| | - Amr Salah Omar
- Anesthesia and Intensive care, Cardiothoracic surgery department, Heart Hospital, Doha, Qatar
| | - Abdulaziz M Alkhulaifi
- Departments of Cardiothoracic Surgery, Heart Hospital, Hamad medical corporation, Doha, Qatar
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17
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Kim K, Kim YS, Woo Y, Yoo SY. Aortic dissection extending from the brachiocephalic artery during transradial coronary catheterization: a case report. BMC Cardiovasc Disord 2020; 20:398. [PMID: 32867684 PMCID: PMC7460766 DOI: 10.1186/s12872-020-01687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iatrogenic acute aortic dissection (AD) is an extremely rare but devastating complication during cardiac catheterization. It can be treated conservatively if it develops in a retrograde form or manifests as an intramural hematoma (IMH) with a micro-intimal tear in the absence of instability. However, only a few reports exist on its natural course and long-term outcomes. CASE PRESENTATION A 78-year-old woman presented to the emergency department with acute chest discomfort. Elective cardiac catheterization was performed via the right radial artery. The patient's brachiocephalic artery was so tortuous that the hydrophilic soft guidewire had to be exchanged for a stiffer one. However, the stiff wire caused the dissection of a tortuous brachiocephalic artery that extended from the sinuses of Valsalva to the proximal descending aorta. Emergent computed tomography showed crescentic aortic wall thickening without a dissection flap. The patient had cardiac tamponade and a gradually thickening thrombosed false lumen. Although the patient was unstable during the first 2 weeks, she was stabilized during hospital stay with only conservative treatment. Consequently, she has been well for over 5 years. CONCLUSIONS Even though the patient showed ominous findings, a good prognosis was expected because the AD was mainly retrograde. Furthermore, the thrombosed false lumen mimicked an IMH on imaging. To the best of our knowledge, this is the first report of an extensive iatrogenic AD originating from the brachiocephalic artery during right transradial catheterization that was treated conservatively despite clinical instability.
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Affiliation(s)
- Kihyun Kim
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Yeon Seong Kim
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Yeongmin Woo
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Sang-Yong Yoo
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea.
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18
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Shah R, Pulton D, Wenger RK, Ha B, Feinman JW, Patel S, Lau C, Rong LQ, Weiss SJ, Augoustides JG, Daubenspeck D, Chaney MA. Aortic Dissection During Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:323-331. [PMID: 32928651 DOI: 10.1053/j.jvca.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ronak Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Stuart J Weiss
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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19
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Ram H, Dwarakanath S, Green AE, Steyn J, Hessel EA. Iatrogenic Aortic Dissection Associated With Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:3050-3066. [PMID: 33008721 DOI: 10.1053/j.jvca.2020.07.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/16/2023]
Abstract
Iatrogenic aortic dissection (iAD) is a relatively rare but a life-threatening complication associated with cardiac surgery. All members of the team caring for cardiac surgical patients (surgeons, perfusionists, and anesthesiologists) must be familiar with this complication to minimize its incidence and improve outcome. The present narrative review focuses on iAD occurring intraoperatively and during the early postoperative period (within 1 month) of cardiac surgery. The review also addresses iAD that occurs late (beyond 1 month) after cardiac surgery and iAD associated with other procedures. iAD occurs in about 0.06% of cases when the ascending aorta is the site of arterial cannulation, in about 0.6% when the femoral or iliac arteries are used, and in about 0.5% when the axillary or subclavian arteries are used. Mortality is estimated to be 30% but is more than double if not recognized until the postoperative period. Site of origin of dissection is most commonly the arterial inflow cannula (∼33%). Other common sites are the aortic cross-clamp or partial occlusion clamp (∼29%) and the proximal saphenous vein anastomosis site (14%). Sixty percent of cases occur during coronary artery bypass graft (CABG) surgery and 17% during aortic valve surgery with or without CABG. iAD may be somewhat less common in off-pump versus on-pump CABG but is still not very rare. Risk factors, presentation, diagnosis, and management are reviewed in detail as is the key role of the use of echocardiography in the early diagnosis of iAD and for guiding its management.
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Affiliation(s)
- Harish Ram
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | | | - Ashley E Green
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Johannes Steyn
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Eugene A Hessel
- Department of Anesthesiology, University of Kentucky, Lexington, KY.
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20
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Puis L, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Wahba A. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Interact Cardiovasc Thorac Surg 2020; 30:161-202. [PMID: 31576402 PMCID: PMC10634377 DOI: 10.1093/icvts/ivz251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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21
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Kunst G, Milojevic M, Boer C, De Somer FM, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Puis L, Wahba A, Alston P, Fitzgerald D, Nikolic A, Onorati F, Rasmussen BS, Svenmarker S. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth 2019; 123:713-757. [DOI: 10.1016/j.bja.2019.09.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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22
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Shea NJ, Polanco AR, D'Angelo A, Bethancourt CN, Sanchez J, George I, Patel V, Takayama H. Improving Outcomes of Iatrogenic Type A Aortic Dissection during Cardiac Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:115-120. [PMID: 31770775 PMCID: PMC6914357 DOI: 10.1055/s-0039-1695729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a standardized approach to management. METHODS From January 1, 2000 through December 31, 2016, 23,275 patients underwent cardiac surgery at our institution. We identified 15 patients who developed IAD. Our approach to management included (1) immediate repair, (2) involvement of a second attending surgeon, (3) aggressive monitoring of malperfusion, (4) securing true lumen arterial perfusion access and systemic cooling, and (5) performance of hemiarch or total arch replacement based on the presence of suspected brain malperfusion. The index operation was also completed at the same time. Patient preoperative characteristics, operative sequence and technique, complications, and outcomes were analyzed with chart review. RESULTS The incidence of IAD at our institution was 0.06% (n = 15). A disproportionate percentage of patients had aneurysmal ascending aortas (33.3%). The index surgery consisted of aortic surgery in five patients (33.3%), coronary bypass in three patients, valve surgery in five patients, and transplantation in one patient. The mechanism of dissection was aortic cannulation in 66.7% and aortic root vent site cannulation in 13.3%. In 46.7% of patients, the IAD was first recognized based on clinical evidence such as aortic hematoma, pericardial bleeding, or abnormal perfusion line pressures. In 40.0%, the diagnosis was made with intraoperative echocardiography without any clinical manifestations. The timing of the diagnosis was at the initiation of cardiopulmonary bypass initiation in 60.0%, while in 40.0% it was recognized after discontinuation of bypass. Hemiarch was done in 73.3% and total arch replacement performed in 13.3%. Isolated ascending repairs were done in two patients. Bypass and cross-clamp times were 229.5 ± 212.7 minutes and 130.5 ± 109.5 minutes, respectively. In-hospital mortality in our cohort was 6.7%. While stroke occurred in one patient, no visceral organ malperfusion was recognized. CONCLUSIONS Incidence of IAD is low with cannulation of an aneurysmal aorta being a risk factor. A standardized approach may result in reduced operative mortality.
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Affiliation(s)
- Nicholas J Shea
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Antonio R Polanco
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Alex D'Angelo
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Casidhe-Nicole Bethancourt
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Joseph Sanchez
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Virendra Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, NYP/CU Medical Center, New York-Presbyterian/Columbia University Aortic Center (VP and HT), New York, New York
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Friedman M, Gollogly A, Pena E, Johnson J, Dulani T. Iatrogenic Aortic Dissection Presenting With Leg Pain Diagnosed With Point-of-care Ultrasound. Clin Pract Cases Emerg Med 2019; 3:376-379. [PMID: 31763592 PMCID: PMC6861033 DOI: 10.5811/cpcem.2019.7.43287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Iatrogenic aortic dissection (IAD) status-post-cardiac catheterization is a rare complication often isolated to the proximal aorta. This is a case of IAD isolated to the distal aorta in a 41-year-old female who presented to the emergency department with right leg pain after undergoing three cardiac catheterizations. The diagnosis of IAD was made upon discovery of an intimal flap in the distal aorta and femoral artery while performing a point-of-care ultrasound to evaluate for deep vein thrombosis.
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Affiliation(s)
- Matthew Friedman
- North Shore University Hospital-Northwell Health, Department of Emergency Medicine, Manhasset, New York
| | - Armin Gollogly
- Long Island Jewish Medical Center-Northwell Health, Department of Emergency Medicine, New Hyde Park, New York
| | - Enrique Pena
- North Shore University Hospital-Northwell Health, Department of Emergency Medicine, Manhasset, New York
| | - Jennifer Johnson
- North Shore University Hospital-Northwell Health, Department of Emergency Medicine, Manhasset, New York
| | - Tina Dulani
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Emergency Medicine, Manhasset, New York
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24
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Adlan AM, Campbell T, Fairbairn T, Aggarwal S, Nawaytou O, Penha D, Todd D, Mahida S. Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges. J Cardiovasc Electrophysiol 2019; 30:2629-2639. [PMID: 31502368 DOI: 10.1111/jce.14163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/30/2019] [Accepted: 08/26/2019] [Indexed: 11/27/2022]
Abstract
The retrograde aortic (RA) route is a widely used access route for mapping and ablation of ventricular tachycardias (VT) arising from the left ventricular endocardium. With the expanding role of VT ablation in patients with significant comorbidity, the choice between the RA and transseptal access routes is an increasingly important consideration. An individualized decision based on the location of the arrhythmogenic substrate, vascular anatomy, aortic valve morphology, and operator experience is necessary when deciding on the optimal access route. Among patients with challenging vascular anatomy, growing experience from structural interventions such as transcatheter aortic valve replacements and peripheral vascular interventions has provided valuable insights into techniques for safe retrograde access. The present review focuses on patient selection for RA access, potential complications associated with the technique, and optimal approaches for access in patients with challenging vascular or aortic valve anatomy.
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Affiliation(s)
- Ahmed M Adlan
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Timothy Fairbairn
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Suneil Aggarwal
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Diana Penha
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Derick Todd
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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25
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Verevkin A, von Aspern K, Leontyev S, Lehmann S, Borger MA, Davierwala PM. Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8:e010940. [PMID: 30612504 PMCID: PMC6405713 DOI: 10.1161/jaha.118.010940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022]
Abstract
Background Iatrogenic coronary artery injuries during percutaneous coronary interventions ( PCI ) often require emergent surgical management. Our study evaluated the early and long-term outcomes in patients undergoing surgical treatment of iatrogenic PCI complications and identified the predictors of operative and long-term mortality. Methods and Results Pre-, intra- and post-operative data and hospital outcomes of 168 consecutive patients undergoing cardiac surgical procedures for iatrogenic complications following PCI between December 1999 and July 2015, were prospectively collected in our computerized database. Logistic and Cox regression analyses were used to identify the independent predictors of operative and long-term mortality. The mean age was 68.5±10.2 years and 35.7% were females. PCI complications included left anterior descending (38.7%), right coronary (29.2%), circumflex (13.1%), left main coronary artery injuries (19.0%), and acute myocardial infarction (66.7%), Type A aortic dissection (7.7%), cardiac tamponade (17.9%), and cardiogenic shock ( CS ) (46.4%). Operative mortality for corrective surgery was 20.8% and was independently predicted by critical preoperative state (odds ratio: 3.5; P=0.01). The 5- and 10-year survival for all patients was 63.9±4.0% and 49.6±5.0%, which improved remarkably in hospital survivors (79.0±4.0% and 64.0±6.0%). Risk factors for long-term mortality were critical preoperative state (hazard ratio: 3.5; P<0.0001) and coronary artery occlusion during PCI (hazard ratio: 2.6; P=0.002). The 5- and 10-year freedom from major adverse cardiac and cerebrovascular events was 59.7±4.0% and 41.9±5.0%. Conclusions Iatrogenic injuries after PCI or coronary angiography requiring surgical correction are associated with a high operative and long-term mortality. Patients developing acute coronary artery occlusion have a more guarded long-term prognosis. Hospital survivors, however, have a superior long-term survival.
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Affiliation(s)
| | | | - Sergey Leontyev
- University department of Cardiac SurgeryLeipzig Heart CenterGermany
| | - Sven Lehmann
- University department of Cardiac SurgeryLeipzig Heart CenterGermany
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26
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Hsu HL, Chen JS, Chiu KM. Modification of Thoracic Endografts to Treat Iatrogenic Type A Aortic Dissection: A Case Report. J Vasc Interv Radiol 2018; 29:740-742. [DOI: 10.1016/j.jvir.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022] Open
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27
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Minatoya K. Con: "Debate: does every ascending aorta repair require at least an open distal anastomosis at the innominate? Or not?". J Vis Surg 2018; 4:49. [PMID: 29682459 DOI: 10.21037/jovs.2018.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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28
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Blossier JD, Gabrysz-Forget F, Tadros VX, Perrault LP. Clampless myocardial revascularization on a healed iatrogenic aortic dissection. Interact Cardiovasc Thorac Surg 2018; 26:362-363. [PMID: 29049713 DOI: 10.1093/icvts/ivx306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
Iatrogenic aortic dissection is an infrequent complication of cardiac catheterization (0.03-0.06%) associated with up to 19% of mortality at 30 days. It was reported to mostly occur when using a 6-Fr guiding catheter to cannulate the right coronary artery. This life-threatening complication usually requires early surgical management and close imaging monitoring and control of systolic blood pressure. This case report describes a patient with iatrogenic aortic dissection during cardiac catheterization in symptomatic coronary artery disease. Conservative management of the limited non-progressive aortic dissection was chosen followed by surgical revascularization with a clampless technique, despite the recent aortic injury.
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Affiliation(s)
- Jean-David Blossier
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Department of Thoracic and Cardiovascular Surgery, CHU Dupuytren, Limoges, France
| | - Fanny Gabrysz-Forget
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Victor-Xavier Tadros
- Department of Interventional Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
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29
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Results of late-onset type A aortic dissection after previous cardiac surgery: Does prior coronary artery bypass grafting affect survival? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:1-7. [PMID: 32082704 DOI: 10.5606/tgkdc.dergisi.2018.14683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/06/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the results of late-onset type A aortic dissection following primary cardiac surgery and to compare the outcomes of patients with or without prior coronary artery bypass grafting. Methods Between January 2005 and December 2015, data of 32 patients (16 males, 16 females; mean age 58.1±10.9 years; range, 45 to 73 years) who were diagnosed with acute type A aortic dissection and underwent repair with a history of previous cardiac surgery at our institution were retrospectively analyzed. The patients were divided into two groups as those with a history of prior coronary artery bypass grafting (n=16) and the patients with a previous cardiac surgery without prior coronary artery bypass grafting (n=16). Results Dissection of the ascending aorta occurred in 32 patients (late acute in 22 and late chronic in 10) who underwent previous cardiac surgery (aortic valve replacement in 12, mitral valve replacement in two, aortic valve replacement + coronary artery bypass grafting in two, coronary artery bypass grafting in 10, mitral valve replacement + coronary artery bypass grafting in four, and dual valve replacement in two patients). The mean time between the first operation and dissection was 4.0±1.5 years. Dissections were treated with the Bentall procedures (n=8), ascending aorta replacement (n=14), ascending aorta replacement + hemiarch replacement (n=4), ascending aorta + aortic valve replacement (n=4) and Bentall + arch replacement (n=2). In-hospital mortality (30-day mortality) was seen in five patients, and oneyear mortality rate was 21.85% (n=7). The survival rates of the all patients for primary cardiac surgery vs primary cardiac surgery + coronary artery bypass grafting were 81.25% vs 75% at one year, 75% vs 68.75% at three years,75% vs 56.25% at five years, 68.75% vs 56.25% at seven years, and 68.75% vs 56.25% at 10 years, respectively (p=0.71, CI: 95%). Conclusion Type-A aortic dissections may develop after cardiac operations with or without coronary artery bypass grafting at any time, and irrespective of associated histologies, they may result in high overall in-hospital mortality. With careful planning by prompt intervention, the outcomes in redo sternotomy operations with or without coronary artery bypass grafting for aortic dissections would be consistent the results of spontaneous aortic dissections.
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30
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Orihashi K, Kihara K, Yamamoto M, Nishimori H. Iatrogenic subintimal aortic dissection that disappeared without a trace. Eur J Cardiothorac Surg 2017; 52:825-826. [PMID: 28481992 DOI: 10.1093/ejcts/ezx130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/07/2017] [Indexed: 11/12/2022] Open
Abstract
A case of an unusual iatrogenic aortic dissection is reported. A 77-year-old male patient in shock status due to acute type A aortic dissection underwent emergency surgery. Systemic perfusion was started via the femoral artery, but another dissection appeared in the descending aorta detected by transoesophageal echocardiography. However, the flap was unusually thin, and there was no change in the pre-existing thrombosed false lumen. These findings suggested subintimal development of dissection. After systemic perfusion was promptly switched to antegrade perfusion, the new dissection could no longer be detected. Since there was no malperfusion or aortic rupture, the ascending aorta was repaired. His postoperative course was uneventful, and there were no significant complications. Unless the aorta is carefully observed at the right time during the operation, such vanishing aortic dissection may be missed and potentially result in 'organ damage of unknown cause'.
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Affiliation(s)
- Kazumasa Orihashi
- Division of Cardiovascular Surgery, Second Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Japan
| | - Kazuki Kihara
- Division of Cardiovascular Surgery, Second Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Japan
| | - Masaki Yamamoto
- Division of Cardiovascular Surgery, Second Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Japan
| | - Hideaki Nishimori
- Division of Cardiovascular Surgery, Second Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Japan
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31
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The "Big Kowalski". J Thorac Cardiovasc Surg 2017; 154:1526. [PMID: 28863958 DOI: 10.1016/j.jtcvs.2017.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 11/23/2022]
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32
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Murzi M, Cerillo AG, Gasbarri T, Margaryan R, Kallushi E, Farneti P, Solinas M. Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years. Interact Cardiovasc Thorac Surg 2017; 24:363-368. [PMID: 28040754 DOI: 10.1093/icvts/ivw370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Methods Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. Results The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P = 0.004), mitral valve replacement (OR = 3.9; P = 0.05), emergent procedure (OR = 3.4; P = 0.014) and conversion to sternotomy (OR = 3.7; P = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P = 0.001), active endocarditis (OR = 5.8; P = 0.07) and hypercholesterolaemia (OR = 2.4; P = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P = 0.033). Conclusions Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.
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Affiliation(s)
- Michele Murzi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Alfredo G Cerillo
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Tommaso Gasbarri
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Rafik Margaryan
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Enkel Kallushi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Pierandrea Farneti
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Marco Solinas
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
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Hornsby WE, Weir W, Khaja M, Yang B. Management of retrograde intraoperative Type A aortic dissection from descending thoracic aortic injury. Interact Cardiovasc Thorac Surg 2017; 26:167-168. [DOI: 10.1093/icvts/ivx274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/26/2017] [Indexed: 11/14/2022] Open
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Tam DY, Mazine A, Cheema AN, Yanagawa B. Conservative Management of Extensive Iatrogenic Aortic Dissection. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2017; 4:229-231. [PMID: 28516099 DOI: 10.12945/j.aorta.2016.16.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022]
Abstract
Iatrogenic aortic dissection (IAD) is a rare complication of percutaneous coronary interventions (PCI). There are no clear guidelines for IAD management, and limited data are available. Registry data and case series combined with extrapolations from our experience with spontaneous Type-A dissections suggest that very limited dissections are often managed conservatively with coronary stenting of the entry tear when possible, while more extensive dissections are managed surgically. We present a case report of a 50-year-old woman who underwent PCI for an ST-elevation myocardial infarction that resulted in an extensive IAD from the ostium of the right coronary artery to the aortic root, ascending aorta, and aortic arch. While the current evidence strongly supports surgical management of such extensive dissection, our patient was successfully managed conservatively with complete resolution according to short-term computed tomography imaging. This case suggests that conservative management may be a reasonable approach for select patients with extensive IAD.
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Affiliation(s)
- Derrick Y Tam
- Divisions of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Divisions of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Asim N Cheema
- Divisions of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Divisions of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Shofu A, Awan GM, Omar B, Qureshi G. Late Presentation of Aortic Aneurysm and Dissection Following Cardiac Catheterization. Cardiol Res 2017; 8:68-72. [PMID: 28515825 PMCID: PMC5421489 DOI: 10.14740/cr537w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/25/2022] Open
Abstract
We report a 63-year-old female with hypertension, hyperlipidemia, and prior pacemaker insertion for atrial fibrillation with symptomatic bradycardia, who was admitted with substernal chest pressure and diaphoresis. Her electrocardiogram revealed atrial fibrillation with demand ventricular pacing and her cardiac biomarkers were negative for acute coronary syndrome. Echocardiogram revealed normal left ventricular systolic function and normal aortic root diameter. Coronary angiography revealed 60-70% obtuse marginal lesion, otherwise mild disease. She was treated medically and discharged in stable condition. She was readmitted 1 month later with recurring chest pain, and shortness of breath which started shortly after her most recent discharge. Blood pressure was 152/93 mm Hg, and heart rate was 105 bpm. BNP was elevated at 1,400 pg/mL, and other cardiac biomarkers were negative. She was treated with diuretics, which resulted in decrease of her blood pressure to 81/51 mm Hg. Repeat echocardiogram revealed severely dilated aortic root, measuring 6.7 cm, with aortic dissection flap and moderate to severe aortic regurgitation. CT angiogram revealed aortic dissection extending proximally to the aortic root above the coronary ostia and distally to the left subclavian artery takeoff. She underwent surgery; she, however, could not be weaned off from cardiopulmonary bypass and died in the operating room. This case illustrates the importance of having a high index of suspicion for iatrogenic aortic dissection following cardiac catheterization as a cause of recurrence of cardiac symptoms, as early detection may help avert a catastrophic outcome, as we report in our patient.
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Affiliation(s)
- Abimbola Shofu
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - G Mustafa Awan
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Ghazanfar Qureshi
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
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36
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Ramadan ME, Buohliqah L, Crestanello J, Ralston J, Igoe D, Awad H. Iatrogenic aortic dissection after minimally invasive aortic valve replacement: a case report. J Cardiothorac Surg 2016; 11:136. [PMID: 27557530 PMCID: PMC4997721 DOI: 10.1186/s13019-016-0531-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/23/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND As minimally invasive cardiac and vascular procedures are on the rise, the incidence of iatrogenic acute aortic dissection (IAAD) will increase. Cardiovascular professionals should be aware about the risk factors, means of prevention and best management options for IAAD in the perioperative setting. CASE PRESENTATION We present the successful clinical management of a complicated case of IAAD after minimally invasive aortic valve replacement. CONCLUSION High index of suspicion is required for prompt diagnosis of IAAD; collaboration of the whole perioperative team is imperative for management of this catastrophe.
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Affiliation(s)
- Mohamed Ehab Ramadan
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, N411 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Lamia Buohliqah
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Juan Crestanello
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - James Ralston
- Perfusion Services, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - David Igoe
- Perfusion Services, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, N411 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
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A Novel Approach for Emergency Repair of Intraoperative Type A Aortic Dissection Through a Left Thoracotomy. Ann Thorac Surg 2016; 102:e147-9. [PMID: 27449452 DOI: 10.1016/j.athoracsur.2016.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 11/20/2022]
Abstract
We observed a case of intraoperative type A dissection during open descending and thoracoabdominal aortic replacement. It is difficult to obtain optimal access to the ascending aorta and aortic root through a left thoracotomy. Transection of the pulmonary trunk provided excellent exposure of the ascending aorta and aortic root, and we successfully managed this devastating adverse event.
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Dolzhansky OV, Shilova MA, Paltseva EM, Fedorov DN, Kocharyan EZ, Pigolkin YI. [Aortic aneurysm in Erdheim's idiopathic cystic medial necrosis in autopsy and forensic medical practice]. Arkh Patol 2016; 78:3-9. [PMID: 27600776 DOI: 10.17116/patol20167843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED To date, the modern Russian literature has not covered morphological studies of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis on autopsy and surgical materials, by using immunohistochemical studies, and it has not estimated the magnitude of pathohistochemical changes in the aortic media either. AIM to conduct a morphological examination of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis, by using the material of pathology and forensic medical departments. MATERIAL AND METHODS 41 surgical samples from patients with idiopathic cystic medial necrosis of the ascending aorta and autopsy samples from 17 sudden deaths from aortic rupture were examined. The aortic wall was histologically and histochemically studied. Immunohistochemical examination was done using antibodies to smooth muscle actin, collagens types I and III, elastin, CD3 (T lymphocytes), CD20 (B lymphocytes), CD45 (leukocyte common antigen), CD68 (macrophages), apoptotic marker p53, tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1). RESULTS Morphological examination showed lamellar unit destruction, fibrosis, medial necrosis, and elastic fiber fragmentation. These signs were assessed by their degree. The immunohistochemical examination of collagens types I and III determined fascicles of randomly positioned fibers. The multidirectional orientation of smooth muscle cells was confirmed by the expression of smooth muscle actin. There was an obvious expression of the apoptotic marker p53 in the smooth muscle cells of the aortic media and in the aortic adventitia. The expression of TNF-α was revealed in the cells of an inflammatory infiltrate in the aneurysm wall and that of ICAM-1 was found in the aortic endothelium, vasa vasorum, and in the cells of an inflammatory infiltrate in the media and adventitia. The paper proposes a design of postmortem and forensic medical diagnosis, which reflects the components of pathogenesis and tanatogenesis in Erdheim's idiopathic cystic medial necrosis and which allows ICD-10 diagnosis coding. CONCLUSION The main histopathological signs of aortic aneurysm in Erdheim's idiopathic cystic medial necrosis were presented; structural changes in the primary components of the aortic wall were characterized; the cells of an inflammatory infiltrate were investigated; and the formulation of autopsy and forensic medical diagnoses was proposed.
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MESH Headings
- Actins/genetics
- Actins/metabolism
- Adolescent
- Adult
- Aged
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/genetics
- Antigens, Differentiation, Myelomonocytic/metabolism
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Case-Control Studies
- Cysts/metabolism
- Cysts/pathology
- Death, Sudden
- Female
- Forensic Pathology
- Humans
- Intercellular Adhesion Molecule-1/genetics
- Intercellular Adhesion Molecule-1/metabolism
- Leukocyte Common Antigens/genetics
- Leukocyte Common Antigens/metabolism
- Male
- Middle Aged
- Myocytes, Smooth Muscle/metabolism
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/metabolism
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- O V Dolzhansky
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - M A Shilova
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E M Paltseva
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - D N Fedorov
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - E Z Kocharyan
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - Yu I Pigolkin
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Leontyev S, Légaré JF, Borger MA, Buth KJ, Funkat AK, Gerhard J, Mohr FW. Creation of a Scorecard to Predict In-Hospital Death in Patients Undergoing Operations for Acute Type A Aortic Dissection. Ann Thorac Surg 2016; 101:1700-6. [PMID: 26794886 DOI: 10.1016/j.athoracsur.2015.10.038] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/03/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated preoperative predictors of in-hospital death for the surgical treatment of patients with acute type A aortic dissection (Type A) and created an easy-to-use scorecard to predict in-hospital death. METHODS We reviewed retrospectively all consecutive patients who underwent operations for acute Type A between 1996 and 2011 at 2 tertiary care institutions. A logistic regression model was created to identify independent preoperative predictors of in-hospital death. The results were used to create a scorecard predicting operative risk. RESULTS Emergency operations were performed in 534 consecutive patients for acute Type A. Mean age was 61 ± 14 years and 36.3% were women. Critical preoperative state was present in 31% of patients and malperfusion of one or more end organs in 36%. Unadjusted in-hospital mortality was 18.7% and not significantly different between institutions. Independent predictors of in-hospital death were age 50 to 70 years (odds ratio [OR], 3.8; p = 0.001), age older than 70 years (OR, 2.8; p = 0.03), critical preoperative state (OR, 3.2; p < 0.001), visceral malperfusion (OR, 3.0; p = 0.003), and coronary artery disease (OR, 2.2; p = 0.006). Age younger than 50 years (OR, 0.3; p = 0.01) was protective for early survival. Using this information, we created an easily usable mortality risk score based on these variables. The patients were stratified into four risk categories predicting in-hospital death: less than 10%, 10% to 25%, 25% to 50%, and more than 50%. CONCLUSIONS This represents one of the largest series of patients with Type A in which a risk model was created. Using our approach, we have shown that age, critical preoperative state, and malperfusion syndrome were strong independent risk factors for early death and could be used for the preoperative risk assessment.
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Affiliation(s)
- Sergey Leontyev
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
| | - Jean-Francois Légaré
- Division of Cardiac Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Karen J Buth
- Division of Cardiac Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Anne K Funkat
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Jochann Gerhard
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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41
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Affiliation(s)
- F. Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute
- Cardiovascular Percutaneous Trial (CAPITAL) Research Group
| | - Bruce M. Jamison
- Department of Pathology and Laboratory Medicine, University of Ottawa
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute
- Cardiovascular Percutaneous Trial (CAPITAL) Research Group
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García Iglesias D, Martín Fernández M, López Iglesias F, Calvo Blanco J, Morís de la Tassa C. Iatrogenic Aortic Dissection: One or More Entities? Ann Thorac Surg 2015; 101:414-5. [PMID: 26694298 DOI: 10.1016/j.athoracsur.2015.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 07/12/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel García Iglesias
- Cardiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, Oviedo, Spain 33011.
| | - María Martín Fernández
- Cardiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, Oviedo, Spain 33011
| | - Fernando López Iglesias
- Cardiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, Oviedo, Spain 33011
| | - Juan Calvo Blanco
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Gukop P, Chandrasekaran V. Principles for Management of Intraoperative Acute Type A Aortic Dissection. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:191-4. [PMID: 27390748 DOI: 10.12945/j.aorta.2015.15.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.
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Affiliation(s)
- Philemon Gukop
- Department of Cardiothoracic Surgery, St George's Hospital NHS Trust, London, United Kingdom
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44
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Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures. Circulation 2015. [DOI: 10.1161/circulationaha.115.015334] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gaudino M, Nesta M, Burzotta F, Trani C, Coluccia V, Crea F, Massetti M. Results of Emergency Postoperative Re-Angiography After Cardiac Surgery Procedures. Ann Thorac Surg 2015; 99:1576-82. [DOI: 10.1016/j.athoracsur.2014.12.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
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47
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 2893] [Impact Index Per Article: 289.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening. Case Rep Cardiol 2014; 2014:809398. [PMID: 25028613 PMCID: PMC4083777 DOI: 10.1155/2014/809398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022] Open
Abstract
Dissection of the ascending aorta is a very rare but life-threatening complication during diagnostic
angiography. We present a case of an elderly woman who underwent an elective diagnostic coronary
angiography, complicated with an iatrogenic ascending aorta dissection that did not involve the
coronary arteries but originated 4 cm distal of the aortic valve. The patient developed cardiogenic
shock due to acute pericardial tamponade and so immediate, life-saving cardiac surgery with
implantation of a supracoronary graft was successfully performed. A biopsy from the excised aorta
showed loss of smooth muscle cells and accumulation of basophilic ground substance, clear features
of cystic media necrosis. This is believed to be the underlying cause of the dissection besides a nonselective injection of the right coronary artery.
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49
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Narayan P, Angelini GD, Bryan AJ. Iatrogenic intraoperative type A aortic dissection following cardiac surgery. Asian Cardiovasc Thorac Ann 2014; 23:31-5. [DOI: 10.1177/0218492314531140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background An increase in the incidence of intraoperative aortic dissection has been reported recently, attributed to the increasingly elderly patient population undergoing cardiac surgery and more off-pump coronary artery bypass. We performed this study to examine current trends, identify risk factors for iatrogenic dissection, and compare iatrogenic intraoperative aortic dissection with spontaneous aortic dissection. Methods The 15,144 consecutive patients who underwent cardiac surgery from April 1999 to April 2011 were studied retrospectively on data collected prospectively. Results Iatrogenic type A aortic dissection following cardiac surgery was diagnosed intraoperatively in 7 (0.04%) patients. Of the 4784 patients who had off-pump coronary artery bypass, only 2 (0.04%) developed iatrogenic intraoperative aortic dissection. Patients in the iatrogenic aortic dissection group were older by a decade (median age 72 vs. 62 years, p = 0.01). The cannulation site in conventional coronary artery bypass grafting and injury by the side-biting clamp in off-pump coronary artery bypass were the most common causes of dissection. Atheromatous disease was identified at the site of cannulation in 5 (71.4%) of the 7 cases. Conclusions Intraoperative aortic dissection remains a rare and unpredictable complication of cardiac surgery, with worse outcomes than spontaneous aortic dissection. Increased age and atheromatous disease at the site of cannulation are significant risk factors for iatrogenic dissection. In this series, off-pump coronary artery bypass did not appear to be a risk factor for iatrogenic aortic dissection.
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Affiliation(s)
- Pradeep Narayan
- Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK
| | | | - Alan J Bryan
- Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK
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50
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Affiliation(s)
- Bartosz Rylski
- Department for Cardiac and Vascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department for Cardiac and Vascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Ernst Weigang
- Department for Vascular Surgery, Vascular Center Berlin-Brandenburg, Academic Hospital of the Charité Berlin, Berlin, Germany
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