Perioperative mortality in patients with acute aortic dissection and coronary artery problems: report of 3 cases and literature review.

Background: Acute type A aortic dissection is a critical condition associated with elevated mortality and disability rates, influenced by numerous risk factors. One significant contributor to intraoperative mortality is intraoperative myocardial ischemia or infarction, which can result in cardiac dysfunction following cardiac reperfusion. Case Description: Case 1 was a 46-year-old male who was admitted for 22-hour sudden chest distress and pain. Intraoperatively, myocardial swelling and cyanosis were observed in the proximal-middle right coronary artery (RCA). Dissection extended to the right and non-coronary sinuses and the aortic annulus, resulting in complete avulsion of the RCA ostium. Aortic total arch replacement and RCA bypass grafting were performed. Following cardiac reperfusion, the patient developed bradycardia and hypotension, ultimately succumbing despite resuscitative efforts, with an estimated blood loss of approximately 2,000 mL. Case 2 was a 55-year-old male who presented with 3-hour sudden chest pain. Intraoperative exploration revealed aortic true and false lumens, along with a longitudinal intimal tear at the anterior wall of the sinotubular junction. There was also distal displacement of the bilateral coronary ostia, and a bicuspid aortic valve exhibiting thickening, calcification, and severe stenosis. Postoperatively, the patient was transferred to the Intensive Care Unit (ICU) but developed hypotension and poor circulation, leading to death after unsuccessful reperfusion. Case 3 was a 25-year-old female who was admitted for a 2-day sudden chest distress radiating to the shoulders. No RCA ostium was identified during the operation. Aortic declamping triggered ventricular fibrillation; sinus rhythm was restored after multiple defibrillations, but unstable circulation and hypotension followed. She died despite resuscitative attempts, with an estimated blood loss of approximately 2,000 mL. Conclusions: This article reports 3 cases of cardiac dysfunction following cardiac reperfusion due to coronary artery issues, aiming to provide insights and caution for the intraoperative management of similar patients.