Iatrogenic type A aortic dissection after cardiac surgical or percutaneous intervention: A systematic review spanning 3 decades.

OBJECTIVES: Iatrogenic type A aortic dissection (ITAAD) affects 0.6 to 1.0% of patients undergoing cardiac surgical or percutaneous intervention and is fatal in 20%. We performed a systematic review of ITAAD to summarize etiologies and management strategies. METHODS: We searched 3 databases for reports of acute ITAAD in adults from 1990 to 2024. Retrospective cohort studies involving ITAAD after cardiac surgery, percutaneous intervention, or diagnostic catheterization were included. Case reports were analyzed separately. Data extracted included procedural cause, treatment modality, and outcome. RESULTS: A total of 235 articles describing 860 cases of ITAAD were included. These included 19 retrospective studies (593 patients) and 216 case reports (267 patients). Of the 19 retrospective studies, 11 focused on surgical causes, 5 on percutaneous causes, and 3 included both. For surgical cases with known etiology, aortic or cardioplegia cannulation (83/135, 61%) was the most common, followed by aortic crossclamp placement (27/135, 20%). Among studies of percutaneous ITAAD (131 patients), the most common etiology was catheter trauma (106/131, 81%), and second was contrast injection (12/131, 9%). Of the 552 cases for which the method of repair was described, 438 of 552 (79%) were managed surgically, 67 of 552 (12%) percutaneously, and 47 of 552 (9%) conservatively. Overall mortality was 24% (141/593). CONCLUSIONS: We performed a systematic review of publications on ITAAD. The most common etiology for surgical ITAAD was cannulation of the aorta. ITAAD from percutaneous intervention has been increasingly reported, is commonly related to catheter manipulation, and is often successfully managed nonsurgically.