Iatrogenic Acute Aortic Dissection in the Era of Minimally Invasive Cardiac Surgery — Experience of a Center and Review of Literature

Abstract

Introduction: Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery. Methods: The purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion. Results: We found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that Abbreviations, acronyms & symbols AAR AD AVR CABG CPB ECC GARY HT IAAD LAD LVA MIAVR = Ascending aorta replacement = Aortic dissection = Aortic valve replacement = Coronary artery bypass grafting = Cardiopulmonary bypass = Extracorporeal circulation = German Aortic Valve Registry = Heart transplant = Iatrogenic acute aortic dissection = Left anterior descending coronary artery = Left ventricular aneurysmectomy = Minimally invasive aortic valve replacement MICS-FC MIDCAB MIMVR MVP MVR OLT OPCAB PARTNER STS TAVR TVR = Minimally invasive cardiac surgery with femoral cannulation = Minimally invasive direct coronary artery bypass = Minimally invasive mitral valve replacement = Mitral valvuloplasty = Mitral valve replacement = One lung transplant = Off-pump coronary artery bypass = Placement of Aortic Transcatheter Valve = Society of Thoracic Surgeons = Transcatheter aortic valve replacements = Tricuspid valve replacement Correspondence Address: Pierpaolo Dambruoso https://orcid.org/0000-0003-1569-9478 Santa Maria Hospital Via De Ferrariis, 22, Bari, Italy Zip Code: 70124 E-mail: [email protected] Article received on October 27th, 2020. Article accepted on December 21st, 2020. DOI: 10.21470/1678-9741-2020-0561