Type A aortic dissection after nonaortic cardiac surgery

Stanger, Olaf; Schachner, Thomas; Gahl, Brigitta; Oberwalder, Peter; Englberger, Lars; Thalmann, Markus; Harrington, Debbie; Wiedemann, Dominik; Südkamp, Michael; Sheppard, Mary N.; Field, Mark; Rylski, Bartosz; Petrou, Mario; Carrel, Thierry; Bonatti, Johannes; Pepper, John (2013). Type A aortic dissection after nonaortic cardiac surgery. Circulation, 128(15), pp. 1602-1611. Lippincott Williams & Wilkins 10.1161/CIRCULATIONAHA.113.002603

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Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occasionally leads to type A aortic dissection (AAD).


One hundred three patients with surgical repair for AAD following nonaortic cardiac surgery were identified. With the use of logistic regression modeling, coronary artery bypass surgery (CABG), either isolated or combined with another procedure in the initial operation, was associated with significantly higher operative mortality in comparison with patients with non-CABG procedures at the time of AAD repair both for all patients (odds ratio, 2.90; 95% confidence interval, 1.09-7.72; P=0.033) and for patients with acute and chronic AAD≥30 days after the initial operation (odds ratio, 3.62; 95% confidence interval, 1.13-11.54; P=0.03). In patients who developed AAD late after the initial operation, operative mortality was highest in patients without preoperative coronary angiography and appropriate management of their native coronary artery disease and graft disease (odds ratio, 5.36; 95% confidence interval, 1.68-17.0; P=0.002). Nearly all the intimal dissection tears were located at sites of previous surgical trauma. Most of the ascending aortas that had dissected initially had a diameter≥40 mm with histological evidence of medial degeneration in resected tissue samples.


In patients who have undergone previous cardiac surgery, preexisting aortic wall pathology contributes to AAD with typical intimal damage at sites of mechanical trauma. The operative mortality was the highest in patients with previous CABG in comparison with patients with non-CABG procedures. Preoperative coronary angiography and operative management of native coronary and graft disease were significantly associated with outcome in patients with previous CABG.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Stanger, Olaf; Gahl, Brigitta; Englberger, Lars and Carrel, Thierry


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Laura Seidel

Date Deposited:

21 Apr 2014 08:36

Last Modified:

10 Mar 2015 13:24

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

aorta, cardiopulmonary bypass, hypertension, pathology, surgery



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