Iatrogenic Aortic Dissection During Elective Cardiac Surgery

Iatrogenic aortic dissection is a rare but catastrophic complication of cardiac surgery. This video shows two cases of extensive type A aortic dissection occurring during elective cardiac surgery. 

The first case occurred during a totally endoscopic mitral valve repair through a right mini-thoracotomy approach in a fifty-seven-year-old woman. A large sheared-off intimal flap was noted by an intraoperative transesophageal echocardiogram immediately after the removal of a Glauber clamp. The ascending aorta was replaced by a conduit, which resulted in a good outcome.  

The second case occurred during an ascending aortic cannulation in a fifty-five-year-old woman with aortic root dilatation. Gross adventitial hematoma rapidly spread to the aortic root, and an extensive type A aortic dissection was confirmed by an intraoperative echocardiogram. This was followed by a successful Bentall procedure and a hemiarch replacement. 

Open distal anastomosis under deep hypothermic circulatory arrest strategy was applied to both cases. Fortunately, intimal flaps did not occlude the cervicobrachial arteries in either case. In the first case, retrograde systemic perfusion via femoral cannulation and in the second case, a deep ascending aorta cannula inserted into the true lumen after noticing the dissection were helpful in managing the events safely without malperfusion syndrome. 

These rare moments caught on camera during elective cardiac surgeries can be informative and educationally valuable, particularly to trainees (1,2). 

References

1. Januzzi JL, Sabatine MS, Eagle KA, et al. Iatrogenic aortic dissection. Am J Cardiol. 2002;89(5):623-6.
2. Ramadan ME, Buohliqah L, Crestanello J, et al. Iatrogenic aortic dissection after minimally invasive aortic valve replacement: a case report. J Cardiothorac Surg. 2016;11(1):136.

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