Multilevel Surgical Repair of Iatrogenic Aortocoronary Dissection: A Lifesaving Strategy.

BACKGROUND

Iatrogenic aortocoronary dissection emerges from the coronary arteries and represents a catastrophic complication of coronary intervention.

CASE SUMMARY: A patient undergoing percutaneous coronary intervention for ST-segment elevation myocardial infarction developed an extensive iatrogenic aortocoronary dissection complicated by cerebral malperfusion. He underwent complex surgery, including David's procedure, total arch replacement with frozen elephant trunk, coronary artery bypass grafting, and extra-anatomical carotid artery bypass. Despite a prolonged postoperative course, the patient achieved complete neurological and functional recovery and remains in excellent clinical condition 2 years postoperatively.

DISCUSSION: Although iatrogenic aortocoronary dissection carries high morbidity and mortality, appropriately tailored surgical strategies can result in favorable long-term outcomes, even in extensive dissections complicated by malperfusion syndrome.

TAKE-HOME MESSAGE: This case underscores aggressive surgical management in complex aortic dissections and the importance of close cardiology-surgery collaboration for severe procedural complications.