Left Ventricular Failure Despite Patent Coronary Arteries in Acute Type A Aortic Dissection

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Acute type A aortic dissection (aTAAD) often leads to myocardial failure.
• This failure is typically linked to coronary artery malperfusion.
• Preserved coronary anatomy in the setting of aTAAD-induced heart failure is less common.

Purpose of the Study:

• To report a case of severe global left ventricular failure following aTAAD.
• To highlight the successful use of mechanical circulatory support (MCS) in a patient with preserved coronary anatomy.
• To emphasize the importance of assessing myocardial viability in persistent post-aTAAD dysfunction.

Main Methods:

• A 57-year-old male patient presented with aTAAD and cardiogenic shock.
• Emergency surgical repair involving total arch replacement with a frozen elephant trunk was performed.
• Postoperative management included venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a microaxial flow pump, followed by left ventricular assist device (LVAD) implantation.

Main Results:

• Coronary angiography confirmed patent coronary ostia and arteries, ruling out structural obstruction.
• Despite initial stabilization, the patient remained dependent on mechanical support.
• Perfusion imaging revealed extensive myocardial damage in the left coronary distribution, necessitating durable LVAD implantation.

Conclusions:

• Severe myocardial injury can occur in aTAAD even with unobstructed epicardial coronary arteries.
• Persistent left ventricular dysfunction after aTAAD repair requires thorough viability assessment.
• Timely transition to durable MCS is vital for patients with persistent myocardial dysfunction post-aTAAD.