Two stage hybrid approach for complex aortic coarctation repair

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Management of adult aortic coarctation with concurrent cardiac pathologies presents significant surgical challenges.
• Lack of standardized guidelines complicates treatment decisions regarding the order, type, and timing of interventions.
• Both one- and two-stage surgical strategies are associated with increased morbidity and mortality.

Observation:

• A case report details an adult male with severe aortic coarctation, ascending aorta aneurysm, and aortic valve regurgitation.
• The patient underwent a two-stage intervention: percutaneous balloon dilatation for aortic coarctation, followed by a Bentall procedure for aortic regurgitation and aneurysm.
• The postoperative period was uneventful, with the patient remaining well three years post-operation.

Findings:

• Percutaneous balloon dilatation is a viable option for severe aortic coarctation in complex cases.
• A staged approach, addressing coarctation first then other pathologies, can be effective.
• Successful management of combined aortic pathologies was achieved with favorable long-term results.

Implications:

• This case suggests a potentially safer and effective therapeutic strategy for complex adult aortic coarctation.
• The findings may inform future treatment guidelines for similar challenging cardiovascular cases.
• Minimally invasive techniques like balloon dilatation can be prioritized in complex aortic disease management.