Background: Intraoperative iatrogenic aortic dissection (IAD) is an uncommon but serious complication of cardiac surgery, and available evidence remains limited, with most reports based on small series. This study summarizes our experience in a high-volume cardiovascular center and compares the findings with published data.

Methods: We retrospectively reviewed 31 consecutive IAD cases treated at Anzhen Hospital from 2020 to 2024, assessing patient characteristics, operative details, and postoperative outcomes.

Results: IAD was identified intraoperatively in 90.3% of patients, with ascending aortic involvement in 80.6%. The main procedures included ascending aorta replacement (45.2%) and hemiarch replacement (22.6%). Mean cardiopulmonary bypass time was 342.6 ± 133.8 min, and 38.7% required circulatory arrest. Major postoperative complications were low cardiac output syndrome (61.3%), neurological injury (25.8%), and acute kidney injury (45.2%). Overall mortality was 38.7%. Review of 17 original studies (1998–2025; >2000 patients) showed a pooled mortality of 32.8%. Patients in our cohort had higher operative risk and more complex procedures, which may partly explain the higher complication and mortality rates.

Conclusions: IAD remains a major intraoperative challenge. Prompt recognition and individualized surgical strategies are essential. These findings provide further insight into intraoperative iatrogenic dissection and may help inform operative and perioperative decision-making.