Schulte K, Attia R* and Young C
Department of Cardiothoracic Surgery, Guy’s and St Thomas’ Hospital, UKFulltext PDF
The incidence of acute type B aortic dissection is 2.9 per 100,000. Bicuspid aortic valve diseaese is a known to increase the risk to 3.1 per 10,000. An age adjusted relative risk increase of over 8-fold. Aortic dissection occurs at an earlier age along with more rapid development of aortic aneurysms. Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occassionally leads to type A aortic dissection. This occurs in 0.12-0.16% of patients with cardiac surgery. The incidence of type B dissection post cardiac surgery is much lower. The incidence and managment of this condition is not well defined in the literature. We report the case of a 48-year-old man with bicuspid mixed aortic valve disease and aortopathy presenting with a 50mm ascending aortic aneurysm who underwent minimally invasive aortic valve and ascending aortic replacement that led to an acute Stanford type B/Debakey IIIb aortic dissection. The patient was successfully treated with thoracic endografting and remains well at 2-year followup. We describe the management of the case and focus on sites of operative trauma at surgery. We discuss aortic morphology during primary surgery and consider the aortic histopathology at the site of primary entry tear. Current guidelines do not provide conclusive information on characteristic features and management in these patients. We discuss emergent thoracic aortic endografting as a treatment option for these high-risk patients and discuss all the management strategies that would improve outcomes for this patient cohort.
Bicuspid aortopathy; Aortic valve replacement; Ascending aortic replacement; Complication; Aortic dissection; Thoracic endovascular aortic repair (TEVAR)
Schulte K, Attia R, Young C. Acute Type B Dissection in a Bicuspid Aortic Valve Patient During Cardiopulmonary Bypass Associated with Arch Cannulation and the use of an End-Hole Cannula. Clin Surg. 2016; 1: 1106..