A Case of Acute Aortic Dissection in an Older Patient of Advanced Age

The patient an 85-year-old female resided in a care facility where she maintained an independent daily activity level. She was discovered hunched over a table in her room, displaying reduced responsiveness and prompting an emergency call. Initially, her blood pressure was within 60 mmHg, and she was transported by ambulance to our hospital. Further examination revealed acute Stanford type A aortic dissection accompanied by signs of cardiac tamponade, necessitating urgent surgery. The operation was performed under general anesthesia and tracheal intubation. After exposing the femoral vessels through an incision in the right groin, cannulation was achieved for cardiopulmonary bypass. Subsequently, a median sternotomy was performed and the pericardium was opened. Blood within the pericardial cavity was carefully exposed and blood pressure was monitored. The pericardial cavity contained a large number of dark red hematomas. A left ventricular vent was inserted and cooling was initiated. The circulatory arrest was achieved at a rectal temperature of 28°C, accompanied by antegrade cerebral perfusion and selective antegrade myocardial protection to facilitate cardiac arrest. The entry tear was located on the dorsal aspect of the ascending aorta. Additionally, the ascending aorta was trimmed proximal to the brachiocephalic artery and a 26-mm Gelweave graft was anastomosed. Circulation was subsequently resumed, and rewarming commenced. The proximal dissection was extended to the non-coronary cusp, where BioGlue was applied to bond the intima and adventitia, followed by a partial adventitial inversion. The proximal anastomosis was then completed. The total operation duration was 366 min. The patient was extubated, and oral intake was initiated the following day. However, postoperative delirium persisted, and the patient developed a cerebral infarction triggered by paroxysmal atrial fibrillation. Her daily activities declined, and she experienced complications including pneumonia and urinary tract infection, which responded to antibiotic therapy. The patient was discharged on postoperative day 49.