Acute type A aortic coarctation after direct cardiac surgery usually occurs in two situations, one is immediate intraoperative and the other is months or years after surgery and can occur after coronary artery disease, aortic coarctation or valve disease, mostly after aortic valve surgery. Although these cases are rare, but the mortality rate is high, the former requires intraoperative change of procedure for immediate treatment, the latter also requires urgent surgical intervention once the diagnosis is clear, but the significance of prevention is greater than treatment, is the cardiothoracic surgeons are worthy of interest in research issues, try to review the following. The earliest report of acute type A entrapment immediately after direct cardiac surgery was reported in 1960, due to the formation of entrapment by retrograde endothelial dissection caused by femoral artery cannulation. The incidence of this complication has been reported in the literature to be 0.16%-0.35%. Despite surgical intervention, mortality rates are as high as 25-50%. The US STS database has 1294 intraoperative cardiac complications of aortic coarctation between 2004 and 2007, with a mortality rate of 50%. This is approximately twice the operative mortality rate for acute type A aortic coarctation compared to the International Registry of Acute Aortic Coarctation study during the same period. It is hypothesized that in addition to factors related to the primary cardiac disease, the difficulty in selecting a new cannulation site to establish extracorporeal circulation quickly after the onset of the entrapment, or the inability to provide adequate cerebral and myocardial protection when dealing with the entrapment due to the location of the lesion and changing the cannulation site, or the inability to repair the descending aorta or thoracoabdominal aorta through a median sternotomy due to the reverse tear of the femoral cannula are all contributing to the high mortality rate. The registry study showed that medically induced coarctation accounted for 5% of the total number of cases, and 69% were caused by the initial surgical procedure. The incidence of aortic coarctation with OPCAB (non-extracorporeal bypass) has been documented to be higher than that with conventional on-pump CABG (bypass with extracorporeal circulation). This may be attributed to the clamping of the lateral wall clamp, and the use of multiple anastomotic devices during non-stop bypass proximal anastomosis, with an overall CABG surgical entrapment incidence of 0.06% compared to 0.04% for OPCABG intraoperative aortic entrapment. The study suggests that Asian ethnicity, hormonal drug use, history of peripheral vascular disease, and age >60 years are risk factors for intraoperative coarctation, whereas aortic constriction and comorbid diabetes do not increase the risk of coarctation. Data suggest that femoral and axillary artery site cannulation is associated with it. However, there is no clear evidence confirming the relevance of cannulation because of the lack of detailed description of whether femoral cannulation was performed at the beginning of the procedure or whether intraoperative detection of entrapment or predicted risk of entrapment led to a change to femoral cannulation. Acute type A coarctation can occur months or years after cardiac surgery and can occur after all types of surgery, including valve, coronary artery bypass, or aneurysm coarctation, with the highest incidence occurring after aortic valve replacement. 0.6% of patients with aortic valve replacement may have a coarctation of type A, and 13% of patients with type A coarctation have a history of aortic valve surgery. However, risk factors for complications of coarctation have rarely been evaluated and indications for ascending aortic replacement discussed. The criteria for prophylactic replacement of the ascending aorta during aortic valve replacement discuss the exclusion of Marfon’s syndrome, and previous studies have shown that aortic regurgitation combined with a brittle and thin ascending aorta is a high risk factor for the development of coarctation, suggesting that the ascending aorta should be replaced if it is 50 mm in diameter. Mortality rates of up to 50% have been reported for combined coarctation from 1 month to 16 years after aortic valve replacement, although there are some case reports. Therefore, it has been suggested that ascending aortic replacement should be performed when the ascending aorta is ≥55 mm in diameter 3,10,11], and in addition, middle-aged patients requiring aortic valve replacement should undergo simultaneous ascending aortic replacement if they have combined hypertensive disease with a diameter ≥50 mm. The literature suggests that the risk of aortic valve diastolic malformation entrapment is greater and is not directly related to valve structure. Most scholars recommend that the ascending aorta should be replaced at the time of aortic valve surgery for diameters ≥50 mm. One retrospective study showed that the occurrence of entrapment after aortic valve replacement appears to be independent of surgical technique. A 16-factor analysis of this study suggested that aortic wall fragility, aortic regurgitation, and aortic wall thinning were independent risk factors for late onset of coarctation, with risk levels of 22%, 14%, and 7%, respectively. Aortic wall fragility combined with aortic regurgitation or aortic wall thinning increased the risk of late coarctation by 64% and 79%, respectively. If all three are present, the risk is increased by 96%. The article therefore suggests that patients with aortic valve replacement ≥43 mm in diameter must be evaluated intraoperatively for risk and may benefit from ascending aortic replacement if both risks are present. Synthesizing most of the literature, the 2010 US and 2014 European guidelines for aortic disease recommend (1) surgical treatment of an ascending aorta ≥55 mm in diameter regardless of etiology. (2) Surgery is indicated in patients with Marfan’s syndrome with an ascending aortic diameter ≥50 mm. Surgical intervention is indicated if there is a family history of entrapment or if the aortic diameter increases at a rate of ≥3 mm/y, reaching 45 mm in diameter; (3) while patients with LDS (Loeys-Dietz) syndrome should be surgically replaced if the ascending main diameter is ≥42 mm; i.e., patients with LD rheumatoid arthritis syndrome or confirmed TGFBR1 or TGFBR2 variants with an aortic diameter of 4.2 cm on transesophageal echocardiography or aortic diameter of 4.2 cm or 4.4-4.6 cm measured by computed tomography or magnetic resonance imaging, surgical intervention should be performed; (5) if aortic valve surgery is performed at the same time, ascending main diameter ≥ 45 mm should be replaced by ascending aorta; it is also necessary to consider the patient’s age, physical condition, valve disease pathology, intraoperative situation, aortic wall thickness, vulnerability, etc., such as the maximum diameter of ascending aorta or aortic root cross-sectional area (cm2) divided by the patient’s height (m) exceeds 10, elective ascending aortic replacement may be considered. The principles of treatment for acute type A aortic coarctation after direct cardiac surgery are equivalent to those for naturally occurring acute type A aortic coarctation, and surgery remains the most effective treatment for this disease. All patients in this category are patients with second or multiple surgeries, which are considerably more difficult to perform, and have higher rates of surgical death and complications than naturally occurring type A aortic coarctation. Therefore, prevention of this type of disease is more important than treatment. Intraoperative complications of coarctation are easily detected. The ascending aorta involvement is most typically characterized by its frequent rapid dilatation, with recalcitrant bleeding often seen at the surgical site (proximal anastomotic site). Aortic perfusion pressure is elevated and is accompanied by systemic hypotension. If any doubt exists, transesophageal ultrasound can quickly clarify the diagnosis. Once identified, the surgeon should immediately perform an aortic cannulation bypass, select a new location for aortic cannulation if necessary, and perform routine aortic coarctation correction with an open anastomosis distal to the ascending aorta under conditions of deep hypothermic arrest of circulation whenever possible. Any manipulation of the aorta and peripheral vasculature can lead to entrapment, including cannulation, proximal anastomosis site, and placement of aortic balloon counterpulsation. Therefore, all surgical procedures should be performed with minimal aortic injury and with improved surgical precision. Although the exact pathogenesis of medically induced coarctation cannot be fully elucidated, it should be carefully avoided. Nanjing First Hospital, Nanjing Cardiovascular Hospital performed surgical treatment of 302 acute type A aortic coarctation cases from April 2004 to December 2014, with a mortality rate of 6.9%, including 23 cases of acute type A aortic coarctation after direct cardiac surgery, accounting for 7.9% of the total number of coarctation cases and 2 deaths (8.7%). Two of these cases were intraoperative complications of coarctation, one of which was an aortic valve replacement followed by ascending aortic coarctation and died of hemorrhage, and the other was a case of bypass surgery under extracorporeal circulation, where coarctation extended to the ascending aorta at the stop-beat fluid perfusion port, which was immediately cooled down and the ascending aorta was replaced by an artificial vessel, which was found in time and the coarctation had not yet reached the distal end of the ascending aorta, so the distal aorta did not undergo open anastomosis and the proximal end of the bridge vessel was anastomosed to the sidewall of the artificial vessel. The patient recovered well and was discharged from the hospital. There were 21 cases of post-operative cardiac entrapment spanning from 3 months to 11 years, including 12 cases after aortic valve replacement, 1 case after double valve replacement, 5 cases after root replacement for Marfon’s syndrome, 1 case after mitral valvuloplasty, and 2 cases of recurrent entrapment after replacement of the ascending main and right hemiarch for acute type A entrapment. Because all patients with type A aortic coarctation after direct cardiac surgery are patients with second or multiple operations, the aneurysmal dilatation of the ascending aorta in some patients can cause the aneurysm to tighten against the sternum, resulting in difficulty in opening the chest, and a few patients can die due to aneurysm rupture during the opening. For such patients, our experience is to carefully inspect the CT film before surgery, and the patient’s aneurysm is indeed close to the sternum latter, heparinization, femoral artery, right internal jugular vein, femoral vein cannulation first, establishment of extracorporeal circulation, and heart void before opening the chest, which can avoid aneurysm rupture during the opening process and reduce surgical death. In conclusion, aortic coarctation, a complication of cardiac surgery, is a clinical problem with low incidence but high mortality. A large amount of research data is only able to further elucidate its pathogenesis in depth. For the most part, the decision to manage the ascending aorta must be based on the patient’s personality characteristics. For example, age, family genetic factors, number of previous openings, left ventricular function, condition of the aortic wall, etc. Only a prospective study with a large sample can give definitive evidence to guide the reduction of the risk of entrapment after direct cardiac surgery and to give more appropriate preventive measures.