Stanford A aortic dissection 40 years after aortic valve replacement with a Starr–Edwards caged-ball prosthesis: a case report

Stanford A aortic dissection is one of the most devastating acute medical conditions due to its high morbidity and mortality. We describe a 77-year-old male patient with a medical history of surgical aortic valve replacement with a still functioning Starr-Edwards caged-ball valve 40 years prior. The patient was promptly diagnosed with an ascending aortic aneurysm and dissection, and an emergency Bentall procedure in deep hypothermic circulatory arrest was performed. This is, to the best of our knowledge, the first Stanford A dissection case described in the literature in a patient with Starr-Edwards valve, and the longest still functioning caged-ball valve to have been replaced with the Bentall procedure. We also discuss the caged-ball valve's unfavorable hemodynamics as a potential predisposing factor of the dissection, as well as the patient's supposed initial bicuspid aortic valve disease which could also predispose to aortic aneurysm formation and dissection.