{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:24:01Z","timestamp":1780514641454,"version":"3.54.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemorrhagic cardiac tamponade is a rare but potentially fatal complication of endovascular aortic intervention, mostly caused by aortic rupture or cardiac perforation; cases without arterial\/cardiac injury are extremely uncommon. Protamine anaphylactic reaction is a common perioperative adverse event, and its synergistic effect with cardiac tamponade on hemodynamic instability is often overlooked in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 63-year-old man with 10\u202fyears of poorly controlled hypertension and a 2-year history of stroke who was diagnosed with DeBakey type I aortic dissection. The patient underwent hemi-arch replacement combined with Bentall operation as the first-stage surgery, and the second-stage descending aorta stent implantation (femoral artery retrograde implantation, chimney stent placement in the innominate artery, and carotid-carotid cross-over bypass) was performed on the 20th postoperative day in line with clinical consensus. During the second-stage surgery, protamine anaphylaxis occurred first, followed by progressive hemodynamic instability; the patient then suffered cardiac arrest due to acute cardiac tamponade. Transesophageal echocardiography (TEE) confirmed a large amount of pericardial effusion with right heart chamber collapse, and subxiphoid surgical pericardial window and drainage were immediately performed, with 300\u202fmL of bloody fluid aspirated. Anticoagulant\/antiplatelet therapy was timely adjusted after drainage, and the patient was discharged without neurological complications 2\u202fweeks later. Serial perioperative biological and physiological data were comprehensively monitored and recorded during the whole process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cardiac tamponade can be readily reversed with timely recognition and intervention, and TEE is the gold standard for its rapid perioperative diagnosis. For patients undergoing staged TEVAR for DeBakey type I aortic dissection with a history of cardiac surgery, long procedural duration, and systemic anticoagulation, tamponade should be highly vigilant even without obvious aortic\/cardiac injury. The protamine reaction can synergize with tamponade to aggravate hemodynamic disorder and mask its early manifestations, requiring enhanced multi-modal monitoring. Timely subxiphoid surgical pericardial window drainage is an effective intervention for tamponade-induced cardiac arrest, and individualized adjustment of anticoagulation therapy is crucial for avoiding rebleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1815531","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:29:07Z","timestamp":1777397347000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac arrest due to tamponade during secondary-stage endovascular stent implantation in a patient with DeBakey type I dissection: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Hongyang","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Anesthesia and Surgery, Xizang Hospital of West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.ejvs.2010.08.024","article-title":"Hybrid repair of the aortic arch in patients with extensive aortic disease","volume":"40","author":"Antoniou","year":"2010","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.athoracsur.2010.12.005","article-title":"Repair of acute type a dissection: our experiences and results","volume":"91","author":"Sun","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1016\/j.jacc.2010.02.015","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease","volume":"55","author":"Hiratzka","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1016\/j.jvs.2010.10.053","article-title":"Complications after aortic arch hybrid repair","volume":"53","author":"Geisb\u00fcsch","year":"2011","journal-title":"J Vasc Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jvs.2013.07.010","article-title":"Aortic arch debranching and thoracic endovascular repair","volume":"59","author":"De Rango","year":"2014","journal-title":"J Vasc Surg"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.11.137","article-title":"Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach","author":"Rosinski Brad","year":"2018","journal-title":"Journal of Thoracic and Cardiovascular Surgery"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1097\/ALN.0000000000002283","article-title":"Early identification of tamponade using focused cardiac ultrasound","volume":"129","author":"Sigakis","year":"2018","journal-title":"Anesthesiology"},{"key":"ref9","first-page":"571","article-title":"Cardiac tamponade during thoracic endovascular aortic repair","volume":"19","author":"Bousselmi","year":"2014","journal-title":"J Res Med Sci."},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.01.058","article-title":"Late complications after hybrid aortic arch repair(Article)","author":"Joo","year":"","journal-title":"J Vasc Surg."},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.06.023","article-title":"American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease Endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY","author":"Klein","year":""},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.849307","article-title":"Surgical Repair of Two Kinds of Type A Aortic Dissection After Thoracic Endovascular Aortic Repair. Frontiers in cardiovascular medicine","author":"Fang","year":""},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-025-02123-4","article-title":"Outcomes of thoracic endovascular aortic repair for complicated type B acute aortic dissection from a multicenter Japanese post-market surveillance study","author":"Seike","year":"2012","journal-title":"General Thoracic and Cardiovascular Surgery"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e23312","article-title":"Integrative analysis reveals chemokines CCL2 and CXCL5 mediated shear stress-induced aortic dissection formation. Heliyon.","author":"Xue","year":""},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2023.12.029","article-title":"Systematic Review of Risk Factors and Outcomes of Post-Implantation Syndrome following Endovascular Aortic Repair. Journal of vascular surgery","author":"D\u2019Oria","year":""},{"key":"ref16","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.chest.2017.11.003","article-title":"Tamponade: hemodynamic and echocardiographic diagnosis","volume":"152","author":"Mark","year":"2017","journal-title":"Chest"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395","article-title":"Stephan B, Bauersachs Johann, et al. 2021 ESC\/EACTS Guidelines for the management of valvular heart disease","author":"Alec","year":"2021","journal-title":"Eur Heart J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2680","DOI":"10.3390\/biomedicines13112680","article-title":"Point-of-care transesophageal echocardiography in emergency and intensive care: an evolving imaging modality","volume":"13","author":"Torre","year":"2025","journal-title":"Biomedicine"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1055\/s-0033-1335736","article-title":"Quality report 2011 of the German Society of Interventional Radiology (DeGIR)\u2013part 2. Endovascular treatment of aortic aneurysms (EVAR)","volume":"185","author":"Heuser","year":"2013","journal-title":"Rofo"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-79830-1_7","article-title":"Echocardiography in the ICU. In: Frankel, H., deBoisblanc, B. (eds) Bedside Procedures for the Intensivist. Springer, New York, NY","author":"Conrad","year":""},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0000000000000649","article-title":"Evolution of the pericardiocentesis technique. Journal of cardiovascular medicine","author":"Maggiolini","year":""},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2023.01.029","article-title":"The Surgical Management of Pericardial Disease. Canadian Journal of Cardiology","author":"Castro-Varela","year":""},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv318","article-title":"2015 ESC Guidelines for the diagnosis and management of pericardial diseases The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). EUROPEAN HEART JOURNAL","author":"Adler","year":""},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1378\/chest.141.4.1129b","article-title":"Perioperative antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"Hirsh","year":"2012","journal-title":"Chest"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2014.10.009","article-title":"Intraoperative Cardiac Emergencies. Critical Care Nursing Clinics of North America","author":"Tyler","year":""},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002944","article-title":"Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma. The journal of trauma and acute care surgery","author":"Nikolay Bugaev, John J Como, Guy Golani, Jennifer J Freeman, Jaswin S Sawhney, Cory J Vatsaas","year":""},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61005-9","article-title":"Management of acute aortic dissection. Lancet","author":"Nienaber Christoph","year":""},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2023.12.025","article-title":"The outcomes of aortic arch repair between open surgical repair and debranching endovascular hybrid surgical repair: A systematic review and meta-analysis. Journal of vascular surgery","author":"Chen","year":""},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1093\/eurheartj\/ehs372","article-title":"Management of pericardial effusions and cardiac tamponade","volume":"89","author":"Imazio","year":"2003","journal-title":"Heart"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.tracli.2025.10.006","article-title":"Perioperative red blood cell transfusion following high-risk oncologic surgery for tumor resection: a systematic review and meta-analysis. Transfusion Clinique et Biologique","author":"Chapalain","year":""}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1815531\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:29:07Z","timestamp":1777397347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1815531\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1815531"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1815531","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"article-number":"1815531"}}