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Management for intraoperative acute aortic dissection during minimally invasive aortic valve replacement

^a Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
^b Department of Pathology, Graduate School of Medical Science, Kyushu University, Japan

*Corresponding author. Tel.: +81-92-642-5557; fax: +81-92-642-5566.

E-mail address: shiget{at}heart.med.kyushu-u.ac.jp (S. Tokunaga).

Although minimally invasive cardiac surgery is more popular nowadays, how we treat an unpredictable intraoperative complication is very important. We report a successful case of minimally invasive aortic valve replacement complicated with an intraoperative acute aortic dissection. We coped with this complication by replacing the ascending aorta with a mini-incision under deep hypothermic circulatory arrest with retrograde cerebral perfusion. Expanding the sternotomy was not done simply because it was felt that it would not provide any additional required exposure for treatment of the dissection. We need to keep in mind that there is a possibility of having an unpredictable complication like this case during minimally invasive surgery.

Key Words: Intraoperative aortic dissection; Minimally invasive cardiac surgery; Aortic valve replacement; Takayasu arteritis