Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation

T. A. Orszulak, J. R. Pluth, Hartzell V Schaff, J. M. Piehler, H. C. Smith, D. C. McGoon

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Abstract

Seven patients (one woman) have been seen with ascending aortic dissections at a mean of 8.8 years to (6 months to 20 yars) after cardiac operation. Previous cardiac operations included saphenous vein coronary artery bypass grafts (CAB) (two), aortic valve replacement (AVR) (one), aortic valvulotomy (one), AVR plus CAB (two), and patch closure of a ventricular septal defect and repair of a perforated aortic cusp (one). During the initial operation, three of seven patients had dilatation of the ascending aorta. Five of seven patients were hypertensive at the time of diagnosis of dissection. Six patients were managed by operation. A composite prosthetic aortic valve and ascending aortic graft with implantation of coronary ostia and saphenous vein grafts was utilized in three patients. In three the repair was by graft replacement of the ascending aorta alone. Five of six patients survived repair and were asymptomatic at discharge. Subsequent problems resulting from distal, descending thoracic, or abdominal aortic extension of the dissection were frequent and necessitated fenestration (one patient) or a graft replacement of the infrarenal aorta (one patient). We conclude that patients may be predisposed to aortic dissection occurring late after cardiac operation, possibly related to prior aortic valvular disease or systemic arterial hypertension. Operative repair is feasible and relatively safe. Follow-up for potential complications of distal aortic problems seems indicated. Techniques of operative repair in these patients are emphasized.

Original languageEnglish (US)
Pages (from-to)538-545
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume83
Issue number4
StatePublished - 1982

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Dissection
Transplants
Aortic Valve
Therapeutics
Aorta
Saphenous Vein
Coronary Artery Bypass
Aortic Diseases
Ventricular Heart Septal Defects
Dilatation
Coronary Vessels
Thorax
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation. / Orszulak, T. A.; Pluth, J. R.; Schaff, Hartzell V; Piehler, J. M.; Smith, H. C.; McGoon, D. C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 83, No. 4, 1982, p. 538-545.

Research output: Contribution to journalArticle

Orszulak, T. A. ; Pluth, J. R. ; Schaff, Hartzell V ; Piehler, J. M. ; Smith, H. C. ; McGoon, D. C. / Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation. In: Journal of Thoracic and Cardiovascular Surgery. 1982 ; Vol. 83, No. 4. pp. 538-545.
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