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

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