Acute type A aortic dissection (AAD) with left coronary artery malperfusion is a critical condition that requires prompt reperfusion to prevent myocardial damage. We report the case of a 66-year-old man with AAD and left coronary malperfusion who underwent emergency surgery. A saphenous vein graft was anastomosed to the LAD before aortic cross-clamping, enabling early reperfusion from the cardiopulmonary bypass circuit. Myocardial function improved markedly during surgery. The patient was successfully weaned from cardiopulmonary bypass and discharged on postoperative day 20 with improved cardiac function. This case highlights the benefit of initiating coronary perfusion prior to aortic cross-clamping as a strategy to improve outcomes in AAD with coronary malperfusion.
Sai et al. (Sun,) studied this question.