Management of patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion due to carotid artery obstruction is still a major challenge and often associated with poor prognosis despite successful surgical aortic repair, due to prolonged cerebral perfusion deficit. Here, we present the first report regarding successful percutaneous recanalization of an internal carotid artery occlusion in the setting of an ATAAD prior to open surgical aortic repair with excellent clinical outcome after three year follow-up, including almost full neurological recovery.

Concomitant surgery on the aortic arch with hypothermic cardiac arrest in the setting of heart transplantation (HTX) is extremely rare. A 67-year-old woman who suffered from ischemic cardiomyopathy was evaluated for HTX. Computed tomography showed diffuse soft and hard atheromatous plaques of the entire aorta. Upon allocation of an appropriate donor organ, the ascending aorta and the proximal aortic arch were replaced using hypothermic cardiac arrest at 28℃ prior to arrival of the donor heart and without clamping of the diseased recipient aorta. After uncomplicated postoperative course the patient was recovered without neurological complications.

A 61-year-old woman with acute myocardial infarction (MI), cardiogenic shock and Impella CP support underwent emergency coronary artery bypass grafting. Postoperatively venous-arterial extracorporeal membrane oxygenation (va-ECMO) became necessary, followed by Impella 5.0 insertion on 7th postoperative day (POD), addition of right ventricular support by TandemHeart due to inadequate flow of Impella system, which then allowed for va-ECMO weaning. Impella und TandemHeart were removed on 14th POD, 31st POD, respectively. Biventricular decompensation following MI was successfully treated by a sequence of different mechanical circulatory support systems allowing an adaptive weaning strategy.