Right Ventricular Failure Following Acute Type A Aortic Dissection: An Alternative Strategy

Abstract

Coronary malperfusion is a complication of aortic dissection, and can lead to ventricular failure. We report 2 cases of right ventricular (RV) failure, following aortic dissection, successfully bridged to recovery using right ventricular assist devices (RVADs). The first was a 54 year-old man, who had difficulty weaning from bypass due to a stunned RV following aortic root replacement. The second was a 34 year-old woman, who after replacement of the ascending aorta, suffered episodes of ventricular fibrillation (VF), and RV failure. Both had an RVAD implanted, allowing eventual recovery. We recommend more widespread use of VADs in such cases.

Semi-Percutaneous Short-Term Support of Right Heart Failure in Acute Aortic Dissection

“…In another case of RV infarction, initially treated by root replacement and direct RCA re-implantation, coronary occlusion occurred in the postoperative course, which finally required a change from temporary to long-term assistance [4]. Mashar et al reported a case of RV ischaemia due to technical problems of the RCA anastomosis requiring emergency venous bypass and temporary assistance, using the Levitronix Centri Mag® [5]. However, the anatomical conditions causing ischaemia varies, and the authors do not discuss their anticoagulation management nor any benefits depending on the configuration for RV support.…”

Profound Hypoxemia From Right Ventricular Failure Following Acute Type A Aortic Dissection

“…These complications arise due to the dissection affecting mesenteric and arch vessels respectively. Congestive heart failure has an incidence of 6% [ 4 ], while right ventricular failure (RVF) has only been reported in case series [ 5 , 6 ]. Such complications significantly increase mortality rate, and should be elucidated early when assessing patients.…”