Iatrogenic Type A Dissection: Case Series and Surgical Management From a High-Volume Aortic Center

BackgroundIatrogenic type A aortic dissection is a rare complication of surgical and nonsurgical cardiac procedures associated with high morbidity. The purpose this study was to describe the intraoperative incidence, management, outcomes iatrogenic dissections at our institution.MethodsRetrospective review institution’s adult surgery database performed between 2002 2018 identify all repairs. Operative reports were reviewed for cause repair strategy. Follow-up surveillance mortality need reintervention queried as available.ResultsOverall, 36 patients undergoing repairs identified (cardiac 0.1%). Of these, 23 (63.9%) related open operation, 5 (13.9%) percutaneous coronary interventions, thoracic endovascular repairs, 3 (8.3%) other procedures. Most underwent hemiarch under circulatory arrest (28/36 [77.8%]), whereas total arch required in (13.9%). Among patients, in-hospital 36.1% (13/36). Those who survived discharge had low subsequent mortality, no differences causes (P = .797). On median follow-up 3.1 years, redo limited 4 (11.1%) successfully treated therapy.ConclusionsIatrogenic represent but serious procedures, those repair. strategy involving an distal anastomosis proximal root reconstruction ensures durable freedom from surgery.