Unexpected Intraoperative Diagnosis of Acute Type A Aortic Dissection in an Octogenarian: Tailored Repair.

BACKGROUND

Acute type A aortic dissection (ATAAD) is a high-mortality surgical emergency, particularly in octogenarians, and may be overlooked with overlapping cardiac symptoms.

CASE SUMMARY: An 86-year-old woman with severe aortic stenosis and multivessel coronary artery disease presented with chest pain. Three months earlier, she underwent evaluation for transcatheter aortic valve replacement, but no intervention was pursued. Because of persistent chest pain, surgical aortic valve replacement and coronary bypass were planned. Intraoperatively, the ascending aorta appeared abnormal, and transesophageal echocardiography confirmed ATAAD. As the dissection originated in the distal ascending aorta, a focal bovine patch repair was performed without ascending aortic replacement. She recovered and remains alive 3 years later.

DISCUSSION: This case underscores the importance of thorough diagnostic investigation and timely imaging in persistent chest pain and an individualized operative approach when unexpected ATAAD is encountered.

TAKE-HOME MESSAGE: Limited repair may be appropriate in carefully selected high-risk elderly patients.