• Jiachen Li, Xinliang Guan, Ming Gong, Xiaolong Wang, and Hongjia Zhang.
• Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Lab for Cardiovascular Precision Medicine Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
• Medicine (Baltimore). 2017 Dec 1; 96 (51): e9206e9206.

RationaleIatrogenic acute aortic dissection (IAAD) induced by cardiac surgery is a fatal complication, with 0.04% of therapeutic procedures and worse outcomes than spontaneous aortic dissection.Patients ConcernsA 64-year-old male complaining of intermittent chest tightness for 4 years received an off-pump coronary artery bypass grifting (OPCABG) and IAAD was found during surgery.DiagnosisUnstable angina, coronary artery triple vessel lesion, IAAD.InterventionsAn ascending aorta replacement surgery was implemented immediately and extracorporeal membrane oxygenation (ECMO) was applied during surgery. The patient suffered from oliguria symptoms and began to receive continuous renal replacement therapy (CRRT) after surgery. What was worse, osteofascial compartment syndrome (OCS) was also confirmed the day after surgery.OutcomesThe CRRT and ECMO were both removed and the condition of the right leg was also stable. But the patient passed away because of uncontrollable sepsis 18 days after the surgery.LessonsOPCABG is clearly the riskiest type of surgery associated with IAADs in cardiac surgical procedures, which should be considered with great concern. Whether ECMO should be used postoperatively in IAAD patients is still a controversial subject, due to some fatal complications linked with it.Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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