Key result
Acute type A dissection can trigger catastrophic LV failure despite patent coronaries, requiring durable LVAD support.
Why the study?
Severe myocardial failure after acute type A aortic dissection is usually attributed to structural coronary malperfusion, but cases with preserved coronary anatomy and severe dysfunction are not well characterized.
Case Report (n=1)
No
Severe myocardial failure can occur after acute type A aortic dissection despite patent coronary arteries, necessitating early viability assessment to guide timely transition to durable mechanical circulatory support.
Catastrophic LV failure may complicate type A dissection despite patent coronaries; hypothesis-generating for viability assessment to guide durable MCS.
Severe myocardial failure after acute type A aortic dissection is usually attributed to structural coronary malperfusion. We report catastrophic global left ventricular failure despite preserved epicardial coronary anatomy, successfully bridged with durable mechanical circulatory support. A 57-year-old man presented with acute type A dissection and cardiogenic shock with extensive precordial ST-segment elevation. Emergency total arch replacement with a frozen elephant trunk was performed. Intraoperative inspection and postoperative coronary angiography confirmed patent coronary ostia and arteries. Postoperatively, venoarterial extracorporeal membrane oxygenation and a percutaneous microaxial flow pump was instituted; extracorporeal membrane oxygenation was weaned on day 4, but the patient remained pump-dependent. Perfusion imaging showed extensive fixed defects in the left coronary distribution, and durable left ventricular assist device implantation was required 6 weeks later. Severe myocardial injury can occur in acute type A aortic dissection without demonstrable fixed coronary obstruction. When dysfunction persists after successful repair, early viability assessment is essential to guide timely transition to durable mechanical circulatory support.
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Nakatsuka et al. (2026) conducted a case report in Acute Stanford type A aortic dissection with cardiogenic shock (n=1). Total arch replacement with frozen elephant trunk followed by mechanical circulatory support was evaluated on Clinical course. Catastrophic global left ventricular failure can occur in acute type A aortic dissection despite preserved epicardial coronary anatomy, requiring durable mechanical circulatory support.
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