Iatrogenic aortic dissection following off-pump coronary artery bypass surgery

Objective. To analyze iatrogenic acute aortic dissection after off-pump coronary artery bypass surgery and identify risk factors. Material and methods. A retrospective analysis enrolled 1703 patients after off-pump coronary artery bypass grafting (December 2021 — December 2024). Mean age was 69.5±2.3 years. There were 1305 (76.6%) men and 398 (23.4%) women. Inclusion criterion was elective off-pump coronary bypass surgery. We evaluated the incidence of intraoperative aortic dissection, injury site and risk factors. Diagnosis was based on transesophageal echocardiography. Results. Intraoperative aortic dissection developed in 4 (0.23%) patients over 64 years old. All patients had arterial hypertension (100%) and type 2 diabetes mellitus (100%). Dissection occurred during side-biting clamp removal in 2 (50%) cases and during clamp placement in 2 (50%) cases. All cases were Stanford type A. Mortality in complete aortic rupture was 50% (n=2). After aortic repair under circulatory arrest (ascending aorta replacement — 1 case, Bentall-De Bono procedure — 1 case), patients were discharged on days 15 and 19. The overall mortality rate was 50%. Conclusion. Iatrogenic acute aortic dissection is a rare but critical complication with 50% mortality. Risk factors are older age, arterial hypertension and side-biting clamp. Prevention requires thorough preoperative assessment and modification of surgical technique.