Delayed visceral malperfusion after Bentall procedure for type A acute aortic dissection

Rapid restoration of flow into the true lumen and obliteration of a false lumen is considered the optimal approach to treating malperfusion syndrome due to acute aortic dissection. However, organ malperfusion can occasionally persist after proximal aortic graft replacement despite redirecting blood flow into the true lumen. A 35-year old man underwent the modified Bentall procedure for Stanford type A acute aortic dissection without organ malperfusion. Ischaemia of the visceral and lower extremities developed on postoperative day 8. Enhanced computed tomography (CT) revealed a thrombus in the false lumen interfering with the true lumen above the celiac trunk. We immediately performed a left axillary-to-bilateral femoral artery bypass. The patient recovered uneventfully and was discharged on postoperative day 28. Although organ malperfusion persisting after proximal aortic graft replacement despite redirecting blood flow into the true lumen is rare, close observation remains imperative after central repair of type A dissection.