Frozen Elephant Trunk for Retrograde Type A Aortic Dissection Within 1 Year Following Heart Transplant.

BACKGROUND

Retrograde type A aortic dissection is a rare but life-threatening condition that may occur spontaneously or iatrogenically, with high associated morbidity and mortality.

CASE SUMMARY: A 44-year-old man with a history of a durable left ventricular assist device and 2 orthotopic heart transplants presented with a spontaneous retrograde type A aortic dissection 9 months after his second transplant. He underwent an urgent fourth-time redo sternotomy for total arch replacement with frozen elephant trunk with bilateral antegrade cerebral perfusion. The patient did not experience major adverse postoperative cardiovascular complications and was eventually discharged home.

DISCUSSION: This case highlights the feasibility of complex aortic surgery in a high-risk, multiply reoperative heart transplant recipient. Given the limited literature on managing aortic dissection after transplant, this report contributes valuable surgical insight.

TAKE-HOME MESSAGE: Aortic dissection is a rare complication after heart transplantation and may require complex aortic surgery at experienced centers for a successful outcome.