Dissection of the ascending aorta is rare after previous open-heart surgery. It can be difficult to manage and represent a formidable surgical challenge. The purpose of this study was to determine the impact of previous cardiac surgery on the presentation, management and outcome of late dissection of the ascending aorta.

From 1994 to 1999, type A dissection developed in 12 patients with a history of previous cardiac surgery. The dissection was acute in 4 patients and chronic in 8. Previous operations were coronary artery bypass grafting (n=7), aortic valve replacement (n=2), aortic valve replacement + coronary artery bypass grafting (n=1), ascending aortic replacement (n=1), ascending aortic replacement + mitral valve repair (n=1).

Dissection was treated by replacement of ascending aorta in 6 patients, replacement of ascending aorta + aortic valve resuspension in 4, composite graft replacement in 2. In patients with previous coronary artery bypass grafting, reimplantation of proximal anastomoses with a button of native aorta was performed in 7 patients, and new saphenous vein graft in 1. Two hospital deaths occured (%16.6).

As a conclusion the patients who have had previous cardiac surgery have distinctly different presentation and management from those with primary dissection. They are usually in hemodynamically stable condition. Patients with previous coronary artery bypass grafting require coronary angiography and intraoperative management of coronary artery disease.

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