Abstract
The onset of Stanford A aortic dissection, which remains a serious disease with a low survival rate, is relatively rare during the follow-up period after open heart surgery. Herein, we report onset factors such as the ascending aorta diameter at the time of surgery and hypertension, and the early outcomes of patients who underwent surgery for Stanford A aortic dissection that developed during the follow-up period following open heart surgery. Subjects were five patients who underwent surgery at our hospital between January 1992 and December 2005 for aortic dissection that developed during the follow-up period following open heart surgery. Initial surgery comprised aortic valve replacement (n = 2), coronary artery bypass surgery (n = 2), and Bentall procedure (n = 1), and the mean time to the onset of aortic dissection was 7.7 years. Surgery for aortic dissection consisted of ascending aortic replacement (n = 4) and arch replacement (n = 1). In addition, coronary revascularization was simultaneously performed for patients who underwent coronary artery bypass surgery as initial surgery. No early mortality was observed and one patient died of pneumonia during the follow-up period.
The most serious risk factor in the onset of aortic dissection following open heart surgery is the ascending aorta diameter, which must be closely monitored during postoperative follow-up if thinning or weakness of the aorta is observed at the time of initial surgery. Simultaneous ascending aortic replacement should be actively performed during initial surgery if the aorta diameter measures ≥ 40 mm at the time of surgery and the aforementioned risk factors are observed, and reoperation must be actively considered if the diameter expands to ≥ 50 mm during postoperative follow-up.
