Dilemma between Pericardiocentesis vs Immediate Aortic Repair in Impending Cardiac Tamponade due to Acute Type A Aortic Dissection; A Case Report

P0104 

Abstract Submission 

Maulidya Ayudika Dandanah (1), Budhi Adhiwidjaja (2), Dicky Aligheri Wartono (3)

(1) Siloam Lippo Village, UPN Medical Faculty, Jakarta, Indonesia, (2) Siloam Lippo Village, Jakarta, Indonesia, (3) Siloam Lippo Village, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia

Maulidya Ayudika Dandanah    -  Contact Me
Siloam Lippo Village, UPN Medical Faculty

Budhi Adhiwidjaja    -  Contact Me
Siloam Lippo Village

dicky a wartono    -  Contact Me
Siloam Lippo Village, Harapan Kita National Cardiovascular Center

Maulidya Ayudika Dandanah    -  Contact Me
N/A

Objective
Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection (AAAD), and the presence of cardiac tamponade should prompt urgent aortic repair. Many centers report performing pericardiocentesis in critical cardiac tamponade to release prolonged hypotension and low cardiac output and maintain the patient's condition before doing an urgent aortic repair. However, the treatment of the patient with moderate cardiac tamponade remains unclear whether we choose pericardiocentesis first or urgent aortic repair without pericardiocentesis. We report our experience with immediate aortic repair of AAAD.

Methods
A 54-year-old female patient was transferred from another hospital with the main complaint of shortness of breath. She also experienced chest pain and epigastric pain. Echocardiography showed moderate pericardial effusion, EF 63%, TAPSE 3.1 cm, anteroseptal hypokinetic and other segments are normal-kinetic. A computed tomography (CT) scan revealed aortic dissection Stanford A DeBakey type 1 and fluid accumulation around the heart.
Intraoperative findings: 400 cc of pericardial blood, entry tear on the ascending aorta, AoX time of 81 minutes, CPB time of 120 minutes, ASCP of 22.47 minutes, and circulatory arrest of 29.28 minutes. The lowest temperature during CPB was 26°C. Cannulation technique: femoral artery and right atrium. We performed ascending replacement + extended hemiarch procedure. The patient was discharged after 10 days in a stable condition.

Results
In this case, we preferred to perform urgent aortic repair without pericardiocentesis because the hemodynamics were still stable. If we had performed pericardiocentesis first, the procedure would have only provide temporary relief by reducing the pressure on the heart, but it would not have prevent the progression of AAAD, resulting in a higher mortality rate.

Conclusion
The choice between these two options may depend on the patient's overall condition, the severity of the tamponade, and the availability of resources and expertise to perform urgent aortic surgery. If we are in an aortic center and adequately prepared preoperatively, open aortic repair is a treatment option.

Dissection