ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Left Ventricular Failure Despite Patent Coronary Arteries in Acute Type A Aortic Dissection.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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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