Haemolytic anaemia due to stenosed double-reinforced grafts after surgical repaired aortic dissection

Haemolytic anaemia due to a stenosed graft is a rare complication after surgery for aortic dissection. We present the case of a patient with haemolytic anaemia and heart failure, who had undergone emergent ascending aorta replacement for type A acute aortic dissection 5 years earlier. Chest computed tomography revealed severe graft stenosis of the proximal anastomosis and transthoracic echocardiography showed severe aortic regurgitation. Surgical treatment was necessary because of heart failure and myocardial ischaemia due to haemolytic anaemia and aortic regurgitation. During the operation, we found an inner graft surrounded by an outer graft and a dilated lumen between the double-reinforced grafts compressing the inner graft. We successfully reconstructed the aortic root with a total arch replacement. To the best of our knowledge, there are no cases in which haemolytic anaemia and AR developed in a patient with acute aortic dissection surgically treated by such a mechanism.