EACTS Expert Consensus Document on Iatrogenic Aortic Dissection
European Journal of Cardio-Thoracic Surgery
Abstract
Iatrogenic aortic dissection (IAD) is a rare but life-threatening complication of open cardiac surgical procedures and catheter-based interventions, associated with high morbidity and mortality. With an ageing population and increasing procedural complexity, the absolute burden of IAD is expected to rise. Unlike spontaneous aortic dissection, IAD typically results from direct intimal injury during cannulation, clamping, catheter manipulation, or device deployment-while its clinical course is strongly influenced by the procedural context and the speed of recognition. Evidence to guide the management of IAD remains limited and is largely derived from registries and observational reports, contributing to substantial variation in diagnostic and therapeutic strategies. This European Association for Cardio-Thoracic Surgery Expert Consensus Document provides the first dedicated, multidisciplinary guidance on IAD, covering definitions and classification, risk factors, prevention, early diagnosis, acute management pathways, and post-discharge surveillance. The document synthesizes available evidence in the literature and expert opinions to offer practical, procedure-specific guidance and algorithms for IAD treatment. The guidance and algorithms include recommendations for rapid identification, containment, and timely surgical or endovascular repair of IAD, as well as conservative management strategies when appropriate, with the aim of supporting clinical decision-making and ultimately improving patient outcomes.
Authors 21
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Maximilian Luehr Aachen
Affiliation as printed
University Hospital RWTH Aachen Department of Cardiac Surgery, ,
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Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research
Affiliation as printed
DZHK (German Centre for Cardiovascular Research) , Partner Site Berlin, Berlin,
Deutsches Herzzentrum der Charité (DHZC) Department of Cardiothoracic and Vascular Surgery, , Berlin,
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Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research
Affiliation as printed
DZHK (German Centre for Cardiovascular Research) , Partner Site Berlin, Berlin,
Deutsches Herzzentrum der Charité (DHZC) Department of Cardiothoracic and Vascular Surgery, , Berlin,
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IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola
Affiliation as printed
Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,
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Affiliation as printed
Medical University of Vienna Department of Cardiac and Thoracic Aortic Surgery, , Vienna,
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Guy's and St Thomas' NHS Foundation Trust · Royal Brompton & Harefield NHS Foundation Trust · Harefield Hospital · Imperial College London
Affiliation as printed
Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust , London,
Imperial College London National Heart and Lung Institute, Faculty of Medicine, , London,
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Affiliation as printed
University of Rzeszow Department of Cardiac Surgery, , Rzeszów,
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Affiliation as printed
Medical University of Vienna Department of Cardiac and Thoracic Aortic Surgery, , Vienna,
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University Hospital Zurich · National Heart, Lung, and Blood Institute
Affiliation as printed
National Institute for Heart and Blood Vessels Dedinje Department of Cardiac Surgery and Cardiovascular Research, , Belgrade,
University Hospital Zurich, University of Zurich Department of Cardiac Surgery, , Zurich,
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University of Freiburg · Universitäts-Herzzentrum Freiburg-Bad Krozingen
Affiliation as printed
Albert Ludwigs University Freiburg Faculty of Medicine, , Freiburg,
University Clinic Freiburg Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, , Freiburg,
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Affiliation as printed
University Hospital Bern Department of Cardiac Surgery, , Inselspital, University of Bern, Bern,
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Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research
Affiliation as printed
DZHK (German Centre for Cardiovascular Research) , Partner Site Berlin, Berlin,
Deutsches Herzzentrum der Charité (DHZC) Department of Cardiothoracic and Vascular Surgery, , Berlin,
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University of Bern · University Hospital of Bern
Affiliation as printed
University Hospital Bern, University of Bern Department of Cardiac Surgery, , Bern,
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Affiliation as printed
Weill Cornell Medicine Department of Cardiothoracic Surgery, , New York, NY,
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Affiliation as printed
Hospital Clínic Barcelona, University of Barcelona Department of Cardiovascular Surgery, , Barcelona,
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Affiliation as printed
Karl Landsteiner Institute of Cardiovascular Research , Vienna,
Klinik Floridsdorf Department of Cardiovascular Surgery, , Vienna,
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University of Trento · Ospedale Santa Chiara
Affiliation as printed
Cardiac Surgery Unit, Ospedale Santa Chiara, University of Trento , Trento,
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Affiliation as printed
Vascular Surgery-Department of Medicine and Surgery, University of Insubria Faculty of Medicine and Surgery , Varese,
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Université Rennes 2 · Centre Hospitalier Universitaire de Rennes · Université de Rennes
Affiliation as printed
Division of Thoracic and Cardiovascular Surgery, University Hospital of Rennes , Rennes,
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Affiliation as printed
Klinikum Links der Weser Department of Cardiac and Thoracic Surgery and Integrative Aortic Centre, , Bremen,