Heart transplantation following a successful bridge-to-bridge strategy in acute type A aortic dissection with left main coronary malperfusion.

A 55-year-old woman developed Stanford type A acute aortic dissection complicated by occlusion of the left main coronary artery. The patient underwent an emergency ascending aortic replacement with concomitant coronary artery bypass grafting to the left anterior descending artery. Owing to extensive myocardial ischemia and the resultant severe cardiopulmonary impairment, the patient could not be weaned from the cardiopulmonary bypass. Therefore, central veno-arterial extracorporeal membrane oxygenation was initiated, with aortic perfusion via a branch of the ascending aortic graft and right atrial drainage. The central veno-arterial extracorporeal membrane oxygenation system was subsequently converted to a paracorporeal left ventricular assist device with an oxygenator, following which respiratory support was no longer required. The patient was listed for heart transplantation and underwent an elective conversion to a durable left ventricular assist device as a bridge-to-bridge strategy. During this operation, relocation of the outflow graft was necessary, and aortic valvuloplasty was performed simultaneously to address the mild residual post-dissection aortic insufficiency. Ultimately, the patient underwent heart transplantation more than 4 years after the bridge-to-bridge operation. An effective sequential mechanical circulatory support strategy, combined with meticulous technical management during bridge-to-bridge surgery, can successfully facilitate bridging to heart transplantation.