Authors
Soborov M.A.1, 2, Parfenov I.M.2, Serdiukov A.S.1, Ismailov S.S.1, Chernikova E.A.2, Mironenko V.A.1
1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow
2 I.M. Sechenov First Moscow State Medical University, Moscow
Abstract
Background. Aortic dissection following cardiac surgery represents a significant clinical challenge, necessitating individualized indications for ascending aorta replacement. Traditional diameter thresholds (≥5.5 cm) are insufficient for predicting dissection risk.
Objective. To demonstrate the importance of comprehensive risk assessment for aortic dissection in post-cardiac surgery patients through analysis of two clinical cases.
Material and Methods. Two cases of type A aortic dissection developing in the late postoperative period after aortic valve replacement and coronary artery bypass grafting are presented. Retrospective analysis of dissection predictors was performed: aortic diameter and morphometry, arterial hypertension, bicuspid aortic valve, atherosclerosis.
Results. In both patients, aortic dissection occurred with ascending aorta diameter <5.5 cm. Risk factors included uncontrolled arterial hypertension, atherosclerosis, and aortic morphological features (elongation, increased curvature). Timely diagnosis and reconstructive interventions resulted in favorable outcomes.
Conclusion. Aortic diameter should not be the sole criterion for prophylactic replacement decisions. Multiparametric risk assessment is required, including aortic morphometry, body surface area indexing, vascular wall evaluation, and strict blood pressure control.
Keywords: aortic dissection, cardiac surgery, risk factors, aortic morphometry, prophylactic replacement, bicuspid aortic valve, arterial hypertension.
References
1. Tirpan AU, Dolmaci OB, Jansen EK, et al. Comparison of cardiovascular risk profiles of patients with type A aortic dissection and thoracic aortic aneurysm: a retrospective multicentre study. BMJ Open. 2025; 15(9): e097306. doi: 10.1136/bmjopen-2024-097306.
2. Flower L, Arrowsmith JE, Bewley J, et al. Management of acute aortic dissection in critical care. J Intensive Care Soc. 2023; 24(4): 409-418. doi: 10.1177/17511437231162219.
3. Sorber R, Hicks CW. Diagnosis and Management of Acute Aortic Syndromes: Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma. Current cardiology reports. 2022; 3(24): 209-216. doi: 10.1007/s11886-022-01642-3.
4. Isselbacher EM, Preventza O, Hamilton Black J 3rd, еt al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 146(24): e334-e482. doi: 10.1161/ CIR.0000000000001106.
5. Ahmed M, Alim Ur. Rahman H, Fahim MAA, et al. Acute type A aortic dissection in patients with non-prior cardiac surgery vs. prior cardiac surgery: a systematic review and meta-analysis. Front Cardiovasc Med. 2024; 26(11): 1438556. doi: 10.3389/fcvm.2024.1438556.
6. von Aspern K, Leontyev S, Etz CD, et al. Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective. Aorta (Stamford). 2022; 10(4): 201-209. doi: 10.1055/ s-0042-1756670.
7. Yuan X, Sun Y, Chen H, et al. Evidence in Cardiovascular Anesthesia (EICA) Group. Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures. Medicine (Baltimore). 2024; 103(12): e37472. doi: 10.1097/MD.0000000000037472.
8. Li B, Meng X, Fu C, et al. The correlation study between the length and angle of ascending aortic and the incidence risk of acute type A aortic dissection. Front. Cardiovasc. Med. 2024; 25(11): 1375601. doi: 10.3389/fcvm. 2024.1375601.
9. Evangelista A, Isselbacher EM, Bossone E, et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018; 137(17): 1846-1860. doi: 10.1161/ CIRCULATIONAHA.117.031264.
10. Sun L, Li X, Wang G, et al. Relationship Between Length and Curvature of Ascending Aorta and Type a Dissection. Front Cardiovasc Med. 2022; 9: 927105. doi: 10.3389/fcvm.2022. 927105.
11. Sun L, Li H, Feng X, et al. Morphological risk of acute type A aortic dissection in the mildly to moderately dilated aorta. Eur J Cardiothorac Surg. 2024; 65(1): ezae016. doi: 10.1093/ ejcts/ezae016.
12. Mahdi A, Akkawi AR, Mahdi M, Farhoud H. The Silent Threat: A Case of Iatrogenic Asymptomatic Aortic Dissection Post Coronary Artery Bypass Grafting. Cureus. 2023; 15(6): e41035. doi: 10.7759/cureus.41035.
13. Pape LA, Tsai TT, Isselbacher EM, et al. International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2007; 116(10): 1120-7. doi: 10.1161/CIRCULATIONAHA.107.702720.
14. Lopez PN, Reymond P, Cikirikcioglu M, et al. Aortic Dilatation on the Edge of Dissection-Do We Operate Too Late? The Ratio between Ascending and Descending Aorta DiameteR (RADAR). J Clin Med. 2023; 12(13): 4400. doi: 10.3390/jcm12134400.
15. Rodríguez-Palomares JF, Dux-Santoy L, Guala A, et al. Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023; 82(5): 448-464. doi: 10.1016/j.jacc.2022.10.042.
16. Sukhacheva T.V., Penyaeva E.V., Soborov M.A. et al. Comparative analysis of morphological changes in the wall of the ascending aorta in patients with bicuspid and tricuspid aortic valves in aortic aneurysm. Clin. exp. morphology. 2024; 13(4): 18-28. (In Russ.) doi: 10.31088/CEM2024.13.4.18-28.
17. Mironenko VA, Soborov MA, Gorodkov AYu, Bokeria LA. Features of blood flow in the aorta as a criterion for the effectiveness of reconstructive interventions. Byulleten’ NCSSH im. A.N. Bakuleva RAMN. 2021; 5(22): 508-514. (In Russ.) doi: 10.24022/ 1810-0694-2021-22-5-508-514.
18. Golukhova EZ, Pursanova DM, Tkhashokova LR, et al. Transthoracic ultrasound assessment of biomechanics of the ascending aorta in aneurysm: comparison with histologic findings. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2025; 26(1): 31-41. (In Russ.) doi: 10.24022/1810-0694-2025-26-1-31-41.
19. Karadzha A, Schaff HV, Frye RL, et al. Post-mortem examination of fatal acute type A aortic dissection: what does it teach us? Eur J Cardiothorac Surg. 2024; 65(1): 432. doi: 10.1093/ejcts/ezad432.
