Objective : To determine the impact of previous cardiac surgery on presentation, management and outcome of late ascending aortic dissection.
Patients and Methods : From 1976 to 1998, 56 patients with a history of previous cardiac surgery developed Type A dissection. Interval from the first operation to presentation was 49±47 months (0.3-180 months). Previous operations were CABG (40), aortic valve replacement (8) and other (8).
Results : Type A dissection was acute in 34 patients and chronic in 22. In acute dissection, aortic regurgitation occurred in 50 %, malperfusion in 12 % and rupture in 18 %; only 2 patients were hemodynamically unstable due to rupture. Of patients with previous CABG, 98 % had preoperative coronary angiography. Type A dissection was treated by supracoronary graft (84 %), Bentall procedure (14 %) or local repair (2 %). Strategies for managing previous CABG included reimplantation of proximal anastomoses with a button of native aorta (29 patients), interposition graft to preexisting saphenous vein grafts (9 patients) and new saphenous vein grafts (20 patients). There were 8 hospital deaths (14 %).
Conclusions : We conclude that 1) patients experiencing Type A dissection late after cardiac surgery infrequently present with tamponade and hemodynamic collapse; 2) patients with previous CABG require coronary angiography, as operative management must account for preexisting coronary artery disease; and 3) operative mortality is low, and this may be attributable to preoperative hemodynamic stability, delineation of coronary anatomy in those with previous CABG, and operative treatment of coronary artery disease.