Acute aortic dissection after proximal anastomoses of vein grafts: A case report

TL;DR

A rare case of aortic dissection following heart bypass surgery is reported, highlighting the risks of surgical techniques and the need for early diagnosis.

Contribution

This case report identifies tangential clamping during vein graft anastomoses as a potential cause of aortic dissection after CABG.

Findings

Aortic dissection occurred two days after CABG involving vein grafts and LIMA-LAD grafting.

CT angiography confirmed the dissection, leading to successful Bentall surgery.

The case emphasizes the importance of careful surgical techniques and early detection to improve outcomes.

Abstract

Coronary artery bypass grafting (CABG) is a critical surgical procedure for treating multi-vessel coronary artery disease (CAD) and significant coronary artery stenosis. Although widely accepted, CABG carries notable morbidity and mortality risks. Aortic dissection (AD), a rare but life-threatening complication, occurs when a rupture in the aortic wall creates a false lumen. This study describes a patient who experienced aortic dissection following on-pump CABG.

A 58-year-old male with a recent lateral myocardial infarction (MI) underwent CABG involving left internal mammary artery (LIMA) grafting to the left anterior descending artery (LAD) and two great saphenous vein grafts. The patient, a smoker with no significant past medical or family history, presented two days post-surgery with severe loss of consciousness and shortness of breath. Computed tomography (CT) angiography revealed an intimal flap in the descending aorta and ascending aorta dilation. The patient was diagnosed with aortic dissection and underwent successful Bentall surgery.

This case highlights the critical need for early recognition of aortic dissection after CABG, as timely diagnosis and treatment are essential for survival. It emphasizes the importance of using careful surgical techniques, such as clamping during graft anastomoses, to reduce risks. Advanced imaging, like CT angiography, remains key to confirming the diagnosis and guiding prompt intervention.

This report underscores the risk of aortic dissection associated with CABG, particularly with tangential clamping techniques. It emphasizes the need for vigilance during surgical procedures and further research to optimize surgical approaches and improve patient outcomes.

•Aortic dissection (AD) is a rare but potentially fatal complication following coronary artery bypass grafting (CABG).•Proximal anastomoses of vein grafts using tangential clamping techniques as a potential underlying causes of AD.•CABG is a revascularization procedure to restore myocardial perfusion in patients with multiple vascular disease•The vulnerable aortic wall is highly susceptible to trauma during surgical manipulation, including clamping and incisions.•The need for vigilance and further research to improve surgical techniques, approaches and patient outcomes.

Aortic dissection (AD) is a rare but potentially fatal complication following coronary artery bypass grafting (CABG).

Proximal anastomoses of vein grafts using tangential clamping techniques as a potential underlying causes of AD.

CABG is a revascularization procedure to restore myocardial perfusion in patients with multiple vascular disease

The vulnerable aortic wall is highly susceptible to trauma during surgical manipulation, including clamping and incisions.

The need for vigilance and further research to improve surgical techniques, approaches and patient outcomes.

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