Prosthetic Repair of the Ascending Aorta in a Patient with Aortic Dissection Type A after Coronary Artery Bypass Grafting (Case Report)
Aortic dissection after cardiac surgery is a rare abnormality in patients after prior coronary artery bypass grafting. This abnormality is often accompanied by aortic valve insufficiency, lower extremity malperfusion syndrome and other symptoms.
The aim. To represent a case of correction of aortic dissection type A, with moderate to severe aortic insufficiency and right lower limb malprofusion syndrome in a patient with overweight after previous cardiac surgery.
Materials and methods. A 39-year-old patient was hospitalized with complaints for increased blood pressure, pain of the right lower limb and it malfunction. During the examination, an aortic dissection type A was diagnosed, and the right lower limb malperfusion syndrome was diagnosed.
Results and discussion. Aortic dissection type A combined with aortic insufficiency and lower extremity malperfusion syndrome is a rare abnormality in overweight patients after the previous coronary artery bypass grafting carried out in 2015. There were no descriptions of such cases in the local literature. Aortic prosthetic repair was performed with the formation of Hemiarch distal anastomosis using retrograde cerebral perfusion and femo-femoral shunting.
Conclusion. Prosthetic repair of the ascending aorta with the formation of Hemiarch distal anastomosis and resuspension of the aortic valve using retrograde cerebral perfusion and deep hypothermia, and formation of femo-femoral shunting provided good outcome in patient with aortic dissection, aortic valve insufficient, lower extremities malperfusion syndrome and overweight.
- Hagl C, Ergin MA, Galla JD, Spielvogel D, Lansman S, Squitieri RP, et al. Delayed Chronic Type A Dissection Following CABG: Implications for Evolving Techniques of Revascularization. Journal of Cardiac Surgery. 2000;15(5):362–7.
- Gillinov AM, Lytle BW, Kaplon RJ, Casselman FP, Blackstone EH, Cosgrove DM. Dissection of the ascending aorta after previous cardiac surgery: Differences in presentation and management. The Journal of Thoracic and Cardiovascular Surgery. 1999;117(2):252–60.
- Tanaka A, Estrera AL. Simple retrograde cerebral perfusion is as good as complex antegrade cerebral perfusion for hemiarch replacement. Journal of Visualized Surgery. 2018;4:50. https://doi.org/10.21037/jovs.2018.02.10
- ЦzзınaE,ЗakıcıM, BaranЗ, Gьmьş F, Цzgьr A, Yazıcıoğlu L, et al. Results of late-onset type A aortic dissection after previous cardiac surgery: Does prior coronary artery bypass grafting affect survival? Turkish Journal of Thoracic and Cardiovascular Surgery. 2018;26(1):1–7. https://doi.org/10.5606/tgkdc.dergisi.2018.14683
- Ko T, Higashitani M, Sato A, Uemura Y, Norimatsu T, Mahara K, et al. Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection. The American Journal of Cardiology. 2015;116(3):463–8. https://doi.org/10.1016/j.amjcard.2015.04.043
- Alaei S, Sundt TM, Sechtem U, Myrmel T, Di Eusanio M, Gleason T, et al. A 15-year Analysis and Descriptive Study of the Incidence, Clinical Characteristics, Management, and Outcomes of Lower Limb Ischemia in Type A and Type B Aortic Dissection Patients: Insights From the International Registry of Acute Aortic Dissection. Circulation. 2015;132:A20003.
- Zhao H, Pan X, Gong Z, Zheng J, Liu Y, Zhu J, et al. Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study. Journal of Thoracic Disease. 2015;7(8):1385–90. https://doi.org/10.3978/j.issn.2072-1439.2015.07.19
- Kreibich M, Rylski B, Bavaria JE, Branchetti E, Dohle D, Moeller P, et al. Outcome after Surgery for Aortic Dissection Type A in Morbidly Obese Patients. The Annals of Thoracic Surgery. 2018;106(2): 491–7. https://doi.org/10.1016/j.athoracsur.2018.03.035
- Gottardi R, Resetar M, Bacher B, Freilibs E, Taheri N, Steindl J, et al. Concomitant Femoro-Femoral Bypass Graft During Surgery for Acute Type A Dissection to Treat Lower Limb Malperfusion. The Annals of Thoracic Surgery. 2015;99(1):307–9. https://doi.org/10.1016/j.athoracsur.2014.02.072
- Crawford ES. The diagnosis and management of aortic dissection. JAMA. 1990;264:2537–41.
- Golledge J, Eagle KA. Acute aortic dissection. Lancet. 2008;372:55–66. https://doi.org/10.1016/S0140-6736(08)60994-0