Spinal cord infarction due to aortic dissection during coronary artery bypass grafting under percutaneous cardiopulmonary support

: We report a case of aortic dissection due to improper position of a percutaneous cardiopulmonary support (PCPS) cannula into the femoral artery during coronary artery bypass grafting (CABG). A 77-year-old man with 3-vessel disease underwent off-pump CABG (OPCAB). Blood pressure suddenly lowered during bypass grafting to the right coronary artery. PCPS was performed between the left femoral artery and the right atrium. Bradycardia occurred 37 min after initiation of PCPS, and transesophageal echocardiography revealed Stanford type A aortic dissection. By converting the perfusion site from the femoral artery to the right axillar artery, the false lumen disappeared and did not reccur after cessation of PCPS. Therefore, the aorta was not replaced. He had however, bilateral leg paralysis after surgery. Magnetic resonance imaging (MRI) revealed spinal cord infarction caused by aortic dissection. Computed tomography (CT) confirmed disappearance of the false lumen and no expansion of the aorta 1 month after surgery. Meticulous care should be taken of the site and size of the arterial cannula in the extracorporeal circuit in such cases.