Surgical repair of delayed chronic Type A dissection after previous Coronary Artery Bypass Grafting

We report of a 57 years-old woman who had undergone coronary artery bypass three years previously. Computed tomography (CT) revealed that the ascending aorta was dilated to about 7cm in diameter, with type A dissection. Angiography revealed that left internal thoracic artery (LITA) graft to left anterior descending artery (LAD) and saphenous vein grafts to posterior descending artery (PDA) branch of the right coronary artery (RCA) and second obtuse marginal (OM) branch of the circumflex artery (CX) correspondingly were patent. Though the risk of surgical treatment via repeat median sternotomy is usually very high in these cases, we successfully performed the reoperation using profound hypothermic circulatory arrest. We dissected the mediastinum by using a sternum retractor for ITA and saphenous vein grafts dissection. We didn't use cardioplegia during profound hypothermic circulation.