Iatrogenic Catheter-Induced Acute Aortic Dissection Type A after Coronary Angiography—A Retrospective Consecutive Case Series

Abstract

Background Acute aortic dissection type A (AADA) is one of the most life-threatening situations and surgical demanding procedures even today. Usually AADA develops spontaneously, but it can be related also to interventional procedures.

Methods We analyzed the data of 14 patients surgically treated in our institution with catheter-induced AADA (ciAADA) during coronary angiography between January 2004 and December 2014. Data were compared with overall AADA patients in this time period (n = 288).

Results Nine of the 14 patients were female. Subjects were significantly older compared to the AADA patients (69 ± 11 vs. 62 ± 11; p = 0.021). At admission, ciAADA patients were more often hemodynamically instable and mechanically ventilated. Twelve patients underwent replacement of the ascending aorta and two patients received a modified Bentall operation. Cardiopulmonary bypass time (210 ± 92 vs. 172 ± 51 min) and cross-clamp time (122 ± 63 vs. 92 ± 40 min) were significantly longer due to additional coronary artery bypass grafts in 71.4 versus 3.1% due to myocardial ischemia. Operative mortality (7.1 vs. 2.1%, p = 0.29) and 30-day mortality (50.0 vs. 10.7%, p < 0.001) were higher in the ciAADA group.

Conclusion Coronary angiography–induced AADA is a rare but severe complication. Due to additional myocardial ischemia and preoperative hemodynamic instability, patients with ciAADA have adverse outcome compared to overall AADA patients.

Keywords

aorta/aortic - cardiac catheterization/intervention (incl. PCI) - computed tomography - CT scan - cardiac

• References

• 1 Yu MY, Gao RL, Chen JL , et al. [Complications in selective coronary angiography: analysis of 9196 cases]. Zhonghua Yi Xue Za Zhi 2003; 83 (2) 91-95
• 2 Conzelmann LO, Krüger T, Hoffmann I , et al; Teilnehmenden GERAADA-Zentren. [German Registry for Acute Aortic Dissection Type A (GERAADA): initial results]. Herz 2011; 36 (6) 513-524
• 3 Ramanath VS, Oh JK, Sundt III TM, Eagle KA. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc 2009; 84 (5) 465-481
• 4 Núñez-Gil IJ, Bautista D, Cerrato E , et al; Registry on Aortic Iatrogenic Dissection (RAID) Investigators. Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or interventional coronary procedures. Circulation 2015; 131 (24) 2114-2119
• 5 Gómez-Moreno S, Sabaté M, Jiménez-Quevedo P , et al. Iatrogenic dissection of the ascending aorta following heart catheterisation: incidence, management and outcome. EuroIntervention 2006; 2 (2) 197-202
• 6 Mehta RH, Suzuki T, Hagan PG , et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Predicting death in patients with acute type a aortic dissection. Circulation 2002; 105 (2) 200-206
• 7 Berndt R, Haneya A, Jussli-Melchers J , et al. Outcome after surgery for acute aortic dissection type A in the elderly: a single-center experience. Thorac Cardiovasc Surg 2015; 63 (2) 113-119
• 8 Schoeneich F, Rahimi-Barfeh A, Grothusen C, Cremer J. Transatrial left-ventricular cannulation in acute aortic dissection type A: a novel cannulation technique. Eur J Cardiothorac Surg 2015; 48 (3) e51-e52
• 9 Noguchi K, Hori D, Nomura Y, Tanaka H. Iatrogenic acute aortic dissection during percutaneous coronary intervention for acute myocardial infarction. Ann Vasc Dis 2012; 5 (1) 78-81
• 10 Pérez-Castellano N, García-Fernández MA, García EJ, Delcán JL. Dissection of the aortic sinus of Valsalva complicating coronary catheterization: cause, mechanism, evolution, and management. Cathet Cardiovasc Diagn 1998; 43 (3) 273-279
• 11 de Barros e Silva PG, Aquino T, Resende MV , et al. Resolution of an acute aortic syndrome with aortic valve insufficiency post-PCI. Am J Case Rep 2014; 15: 508-513
• 12 Bekler A, Özeren A, Gazi E, Temiz A, Altun B. Successful aorta-osteal stenting after iatrogenic acute type-A aortic dissection during primary percutaneous coronary intervention. Balkan Med J 2014; 31 (4) 352-355
• 13 Boukhris M, Tomasello SD, Marzà F, Azzarelli S, Galassi AR. Iatrogenic aortic dissection complicating percutaneous coronary intervention for chronic total occlusion. Can J Cardiol 2015; 31 (3) 320-327
• 14 Yarlioglues M, Tasdemir K, Kaya MG, Kalay N. Aortic and coronary artery dissection during percutaneous coronary intervention: a case report and review article. Clin Cardiol 2011; 34 (5) 283-286
• 15 Chen YM, Chang CP, Wu CC, Shen CH, Ho WM. Cardiac catheterization-induced type-A aortic dissection detected by intra-operative transesophageal echocardiography--a case report. Acta Anaesthesiol Taiwan 2004; 42 (1) 45-48
• 16 Núñez-Gil IJ, Bautista D, Pérez-Vizcaíno MJ, Cerrato E, Salinas P, Fernández-Ortiz A. Type A iatrogenic aortic dissection following catheterization without coronary involvement: long-term prognosis. Rev Esp Cardiol (Engl Ed) 2015; 68 (3) 254-255
• 17 Lambelin M, Janssens L, Haenen L. Iatrogenic ascending aorta dissection during diagnostic coronary angiography: rare but life-threatening. Case Rep Cardiol 2014; 2014: 809398
• 18 Rylski B, Hoffmann I, Beyersdorf F , et al. Iatrogenic acute aortic dissection type A: insight from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2013; 44 (2) 353-359 , discussion 359
• 19 Al-Mallah MH, Aljizeeri A, Villines TC, Srichai MB, Alsaileek A. Cardiac computed tomography in current cardiology guidelines. J Cardiovasc Comput Tomogr 2015; 9 (6) 514-523
• 20 Roffi M, Patrono C, Collet J-P , et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). 2016; 37 (3) 267-315