Durable Left Ventricular Assist Device Implantation in a Patient With Iatrogenic Type A Aortic Dissection.

BACKGROUND

Acute myocardial infarction with cardiogenic shock often requires urgent mechanical circulatory support (MCS) and, if recovery fails, definitive replacement therapy. We report the complex management of a 49-year-old man who developed an iatrogenic type A aortic dissection (iTAAD) after failed percutaneous coronary intervention.

CASE SUMMARY: Initial stabilization with an Impella device was complicated by vascular injury and hemodynamic instability, requiring escalation to advanced MCS. As the iTAAD remained stable without systemic malperfusion, conservative management was chosen. Persistent severe left ventricular dysfunction prevented recovery, leading to implantation of a durable left ventricular assist device.

DISCUSSION: Unlike spontaneous dissections, iTAADs arise from focal procedural injury, and-without malperfusion-may be safely managed conservatively, although no formal guidelines exist.

TAKE-HOME MESSAGE: In selected patients with stable iTAAD and cardiogenic shock due to concomitant myocardial infarction, a "watchful waiting" strategy combined with MCS can safely bridge to durable left ventricular assist device implantation.