Type A Aortic Dissection After Extra-Anatomic Coarctation Repair

BACKGROUND: Type A aortic dissection (TAAD) after prior extra-anatomic coarctation repair is rare and may pose technical challenges for aortic reconstruction. CASE SUMMARY: A 32-year-old asymptomatic man, 13 years after extra-anatomic ascending-to-descending aortic bypass for coarctation associated with a bicuspid aortic valve, was found on surveillance imaging to have a chronic TAAD with a 7-cm aortic root and ascending aortic aneurysm. He underwent redo median sternotomy with mechanical aortic root replacement, zone 2 total arch reconstruction, and reimplantation of the existing bypass graft. Postoperative recovery was uneventful, and follow-up imaging confirmed graft patency and successful repair. DISCUSSION: This case highlights the feasibility of complex aortic root and arch reconstruction while preserving prior extra-anatomic surgical grafts in the setting of TAAD. TAKE-HOME MESSAGES: TAAD can occur years after extra-anatomic coarctation repair. Advanced reconstruction techniques, including arch-first debranching and extra-anatomic bypass preservation, can achieve favorable outcomes in complex reoperative scenarios.