Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures

Author:

Yuan Xi12,Sun Yanting23,Chen Huaqiu4,Lan Qiqing1,Wu Wen1,Yao Yuntai2,

Affiliation:

1. Department of Anesthesiology, Xichang People’s Hospital, Xichang, China

2. Department of Anesthesiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Fuwai Hospital, Peking Union Medical College, Beijing, China

3. Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, China

4. Department of Laboratory, Xichang People’s Hospital, Xichang, China.

Abstract

Background: Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes. Methods: Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed. Results: Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment). Conclusions: Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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