Surgical repair of type A aortic dissection involving the left main coronary artery can successfully treat cardiogenic shock, though persistent postoperative LV dysfunction highlights the need for rapid intervention or preoperative perfusion.
Persistent LV dysfunction after successful repair cautions on QoL expectations; leaves open optimal timing and adjunctive strategies.
This report describes 2 cases of a type A acute aortic dissection combined with myocardial infarction caused by a retrograde dissection into the left main trunk of the coronary artery. Successful surgical treatments, including the replacement of the ascending aorta, aortic valve resuspension and coronary artery bypass grafting, were performed in both patients, and they recovered well from cardiogenic shock. However, left ventricular function of both patients remained depressed postoperatively, which limited their quality of life. Because no definite method for salvaging infarcted myocardium has yet been established, either more timely surgery or the preoperative placement of a perfusion catheter in the left main coronary artery is mandatory.
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Tominaga et al. (1999) studied this question.
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