{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:44:30Z","timestamp":1787503470359,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018684","name":"National Health Commission","doi-asserted-by":"publisher","award":["2023ZD0504404"],"award-info":[{"award-number":["2023ZD0504404"]}],"id":[{"id":"10.13039\/501100018684","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Intraoperative iatrogenic aortic dissection (IAD) is an uncommon but serious complication of cardiac surgery, and available evidence remains limited, with most reports based on small series. This study summarizes our experience in a high-volume cardiovascular center and compares the findings with published data. Methods: We retrospectively reviewed 31 consecutive IAD cases treated at Anzhen Hospital from 2020 to 2024, assessing patient characteristics, operative details, and postoperative outcomes. Results: IAD was identified intraoperatively in 90.3% of patients, with ascending aortic involvement in 80.6%. The main procedures included ascending aorta replacement (45.2%) and hemiarch replacement (22.6%). Mean cardiopulmonary bypass time was 342.6 \u00b1 133.8 min, and 38.7% required circulatory arrest. Major postoperative complications were low cardiac output syndrome (61.3%), neurological injury (25.8%), and acute kidney injury (45.2%). Overall mortality was 38.7%. Review of 17 original studies (1998\u20132025; &gt;2000 patients) showed a pooled mortality of 32.8%. Patients in our cohort had higher operative risk and more complex procedures, which may partly explain the higher complication and mortality rates. Conclusions: IAD remains a major intraoperative challenge. Prompt recognition and individualized surgical strategies are essential. These findings provide further insight into intraoperative iatrogenic dissection and may help inform operative and perioperative decision-making.<\/jats:p>","DOI":"10.3390\/jcdd13010005","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:05:22Z","timestamp":1766498722000},"page":"5","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Iatrogenic Aortic Dissection in Cardiovascular Surgery: Case Series and Literature Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Jinjing","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peirong","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/j.athoracsur.2010.05.023","article-title":"Aortic dissection as a complication of cardiac surgery: Report from the Society of Thoracic Surgeons database","volume":"90","author":"Williams","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1053\/j.jvca.2020.07.084","article-title":"Iatrogenic Aortic Dissection Associated With Cardiac Surgery: A Narrative Review","volume":"35","author":"Ram","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"537","DOI":"10.4103\/0971-9784.166463","article-title":"Intraoperative aortic dissection","volume":"18","author":"Singh","year":"2015","journal-title":"Ann. Card. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1016\/j.athoracsur.2009.11.020","article-title":"Management of type A aortic dissections: A meta-analysis of the literature","volume":"89","author":"Jonker","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","first-page":"462","article-title":"Acute aortic dissection early after off-pump coronary surgery: True frequency underestimated?","volume":"36","author":"Tabry","year":"2009","journal-title":"Tex. Heart Inst. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0003-4975(00)02136-6","article-title":"Increased incidence of acute ascending aortic dissection with off-pump aortocoronary bypass surgery?","volume":"71","author":"Chavanon","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","first-page":"691","article-title":"Iatrogenic Acute Aortic Dissection in the Era of Minimally Invasive Cardiac Surgery\u2014Experience of a Center and Review of Literature","volume":"36","author":"Dambruoso","year":"2021","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1186\/s13019-024-03002-4","article-title":"Aortic arch registry of type a aortic dissection (AoArch)\u2014Rationale, design and definition criteria","volume":"19","author":"Nappi","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1055\/s-0042-1756670","article-title":"Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective","volume":"10","author":"Leontyev","year":"2022","journal-title":"Aorta"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Biancari, F., Pettinari, M., Mariscalco, G., Mustonen, C., Nappi, F., Buech, J., Hagl, C., Fiore, A., Touma, J., and Dell, A.M. (2022). Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226729"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"140","DOI":"10.31083\/j.rcm2304140","article-title":"Immediate Recognition and Surgical Treatment of Iatrogenic Acute Type A Aortic Dissection Is Associated with Low Hospital Mortality and High Intermediate-Term Survival","volume":"23","author":"Wang","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/S1010-7940(98)00224-3","article-title":"Acute ascending aortic dissection complicating open heart surgery: Cerebral perfusion defines the outcome","volume":"14","author":"Ruchat","year":"1998","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/S0002-9149(01)02312-8","article-title":"Iatrogenic aortic dissection","volume":"89","author":"Januzzi","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1510\/icvts.2005.114900","article-title":"Intraoperative iatrogenic type A aortic dissection and perioperative outcome","volume":"5","author":"Fleck","year":"2006","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E231","DOI":"10.1532\/HSF98.20081032","article-title":"Perioperative type I aortic dissection during conventional coronary artery bypass surgery: Risk factors and management","volume":"11","author":"Ketenci","year":"2008","journal-title":"Heart Surg. Forum"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/j.1540-8191.2008.00624.x","article-title":"Predictors and outcomes associated with intraoperative aortic dissection in cardiac surgery","volume":"23","author":"Hurt","year":"2008","journal-title":"J. Card. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1177\/0218492309341784","article-title":"Eight-year experience of intraoperative aortic dissection","volume":"17","author":"Lin","year":"2009","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1510\/icvts.2009.231001","article-title":"Iatrogenic type A aortic dissection during cardiac surgery","volume":"10","author":"Hwang","year":"2010","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1093\/ejcts\/ezr070","article-title":"Iatrogenic type A aortic dissection during cardiac procedures: Early and late outcome in 48 patients","volume":"41","author":"Leontyev","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ejcts\/ezt055","article-title":"Iatrogenic acute aortic dissection type A: Insight from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"44","author":"Rylski","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/0218492314531140","article-title":"Iatrogenic intraoperative type A aortic dissection following cardiac surgery","volume":"23","author":"Narayan","year":"2015","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1055\/s-0039-1695729","article-title":"Improving Outcomes of Iatrogenic Type A Aortic Dissection during Cardiac Surgery","volume":"7","author":"Shea","year":"2019","journal-title":"Aorta"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1016\/j.jtcvs.2025.05.011","article-title":"Iatrogenic aortic dissection: Insights from the International Registry of Acute Aortic Dissection","volume":"170","author":"Harris","year":"2025","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ezaf135","DOI":"10.1093\/ejcts\/ezaf135","article-title":"Iatrogenic aortic dissection in minimally invasive cardiac surgery for atrioventricular valves and atrial structures","volume":"67","author":"Bauer","year":"2025","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.athoracsur.2025.06.016","article-title":"Surgical Outcomes of Iatrogenic Acute Type A Aortic Dissection During Catheter-Based Procedures: An STS Cardiac Surgery Database Analysis","volume":"120","author":"Liu","year":"2025","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/1\/5\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T05:12:18Z","timestamp":1766639538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/1\/5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,21]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcdd13010005"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13010005","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,21]]}}}