Acute ascending aortic dissection complicating open heart surgery: cerebral perfusion defines the outcome
| Autor: | Frank Stumpe, Adam Fischer, Ludwig K. von Segesser, Michel Hurni, Patrick Ruchat |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Acute Disease Aged Aneurysm Dissecting/epidemiology/*etiology/surgery Aorta/injuries/surgery Aortic Aneurysm/epidemiology/*etiology/surgery Blood Vessel Prosthesis Implantation *Cardiac Surgical Procedures Cardiopulmonary Bypass Case-Control Studies Cerebrovascular Circulation/*physiology Female Heart Arrest Induced Humans Intraoperative Care Intraoperative Complications/*epidemiology Male Middle Aged Perfusion Postoperative Complications/*epidemiology Retrospective Studies Treatment Outcome Blood Vessel Prosthesis Implantation Coronary artery bypass surgery Postoperative Complications Aortic valve replacement Internal medicine medicine.artery Ascending aorta medicine Humans Cardiac Surgical Procedures Intraoperative Complications Aortic rupture Aorta Aged Retrospective Studies Aortic dissection Mitral valve repair Cardiopulmonary Bypass Intraoperative Care business.industry Cardiogenic shock General Medicine Middle Aged medicine.disease Aortic Aneurysm Cardiac surgery Surgery Perfusion Aortic Dissection Treatment Outcome surgical procedures operative Case-Control Studies Cerebrovascular Circulation Acute Disease Heart Arrest Induced Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery, vol. 14, no. 5, pp. 449-52 |
| Popis: | Objective: This retrospective study was designed to assess the risks of acute ascending aorta dissection (AAD) as a rare but potentially fatal complication of open heart surgery. Method: Among 8624 cardiac surgical procedures under cardiopulmonary bypass (CPB) and cardioplegic myocardial protection from 1978 to 1997, 10 patients (0.12%) presented with a secondary or so called ‘iatrogenic’ AAD. There were seven men and three women, mean age 64 ∠ 9 years, ranging from 47 to 79. The original procedures involved five coronary artery bypass grafts (CABG), one repeat CABG, one aortic valve replacement (AVR), one AVR and CABG, one mitral valvuloplasty (MVP) and CABG and one ascending aorta replacement. We retrospectively analyzed their hospital records. Results: Group I consisted of seven patients with AAD intraoperatively and group II consisted of three patients who developed acute AAD 8‐32 days after cardiac surgery. In group I, treatment consisted of the original procedure, plus grafting of the ascending aorta in six patients and closed plication and aortic wrapping in one. In group II, two patients received a dacron graft and one patient developed lethal tamponnade due to aortic rupture before surgery. Postoperatively, six patients responded well and three died (33%), two patients from group I on the 2nd postoperative day with severe post-anoxic encephalopathy, and one from group II with severe peroperative cardiogenic shock. Conclusion: Preventing AAD with the appropriate means remains standard practice in cardiac surgery. If AAD occurs, it requires prompt diagnosis and interposition graft to allow a better prognosis. Intraoperative AAD happens at the beginning of CPB jeopardizing perfusion of the supraaortic arteries. © 1998 Elsevier Science B.V. All rights reserved |
| Databáze: | OpenAIRE |
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