From Cardiac Arrest to Survival: Managing Acute Type A Aortic Dissection With Emergent Surgery

TL;DR

A 68-year-old man survived a life-threatening aortic dissection after cardiac arrest through emergency surgery and multidisciplinary care.

Contribution

This case study presents a rare successful outcome of emergent surgical management in a cardiac arrest patient with acute type A aortic dissection.

Findings

Emergency surgery with full circulatory arrest and axillary cannulation successfully treated aortic dissection in a cardiac arrest patient.

Postoperative imaging confirmed resolution of effusions and stable chronic dissection of the descending aorta.

The patient showed neurological recovery without brain injury despite coagulopathy and delayed improvement.

Abstract

Acute type A aortic dissection (AAD) is a life-threatening cardiovascular emergency with extremely high mortality, especially if complicated by cardiac arrest. Early diagnosis and prompt surgical intervention are essential for survival but pose major difficulties in unstable patients. We describe the clinical course of a 68-year-old man with out-of-hospital cardiac arrest due to AAD. Cardiopulmonary resuscitation was performed on-site and was in progress during transport. After achieving return of spontaneous circulation in the emergency department, emergency coronary angiography ruled out coronary artery disease and revealed aneurysmal dilation of the ascending aorta, severe aortic valve regurgitation, and an intimal flap consistent with dissection. The diagnosis of AAD from the aortic root to the iliac arteries, with pericardial and left pleural effusions, was confirmed by total-body computed tomography. Emergent surgical management included the replacement of the dissected ascending aorta with a 28 mm synthetic graft and replacement of the severely regurgitant aortic valve with a 21 mm bioprosthesis. The procedure was carried out with full circulatory arrest and axillary cannulation. The patient’s postoperative course was complicated by coagulopathy and slow gradual neurological improvement, but ultimately, he had no evidence of ischemic or hemorrhagic brain injury. He was discharged in stable condition on the 15th postoperative day. Follow-up imaging showed stable chronic dissection of the descending aorta, as well as complete resolution of pleural and pericardial effusions. This case highlights the complexities of diagnosing and managing AAD in a patient presenting with cardiac arrest. It also demonstrates the importance of multidisciplinary collaboration, timely imaging, and advanced surgical techniques in overcoming the significant challenges associated with this critical condition.

Figures