Right ventricular failure due to right coronary occlusion is an uncommon but serious complication of acute aortic dissection. We report a patient with right coronary occlusion from acute type A aortic dissection who developed right ventricular failure that persisted after proximal aortic repair, rendering weaning from extracorporeal circulation unsuccessful. With a bidirectional cavopulmonary shunt and the use of an intraaortic balloon, the patient could be weaned successfully from cardiopulmonary bypass. This procedure may be an alternative to a right ventricular assist device in selected candidates.