Aortic dissections complicating open cardiac surgery: Report of three cases

Between June 1991 and February 999, three patients suffered ascending aorti c dissection as a complication of cardiopulmonary bypass operations with ao rtic cannulation at our hospital. The dissection occurred during the operat ion in two of the three patients and several months after the operation in one. Among a total of 2207 cardiac operations performed during this period, the incidence of perioperative ascending aortic dissection was 0.14%. In a ddition to visual inspection and palpation, either epicardial or transesoph ageal echocardiography proved extremely useful for establishing an intraope rative diagnosis of ascending aortic dissection as a complication of open c ardiac operation. One of the three patients underwent closed plication but subsequently died of vital organ ischemia. In this case, failure of reappro ximation of the injured intima by closed plication might have led to extens ion of the dissection. Despite prolonged cardiopulmonary bypass and myocard ial ischemic time, graft replacement of the ascending aorta was successfull y carried out in the other two patients. Thus, we believe that graft replac ement of the ascending aorta should be performed for patients with extensiv e aortic dissection complicating an open cardiac operation.