Combined ascending aortic and hemi-arch replacement with coronary bypass in a young woman with systemic lupus erythematosus and prior inferior STEMI

Introduction Systemic lupus erythematosus (SLE) confers markedly increased cardiovascular risk, including premature coronary artery disease and rare but high-risk aortic aneurysms. Surgical decision-making becomes challenging when significant aortic pathology coexists with advanced coronary disease. Case presentation A 47-year-old woman with longstanding SLE and prior inferior STEMI presented with recurrent chest pain and exertional dyspnea. Workup revealed tight in-stent restenosis of the right coronary artery and a 5.3-cm ascending/proximal arch aneurysm. A multidisciplinary heart team recommended single-stage repair. She underwent supracoronary ascending aortic and hemi-arch replacement under hypothermic circulatory arrest, along with saphenous vein bypass to the posterior descending artery. Postoperative imaging confirmed excellent aortic reconstruction and a patent graft, and recovery was uneventful. Conclusion This case illustrates the accelerated vascular complications of SLE and highlights the feasibility and benefit of combined aortic replacement and coronary bypass in selected young patients with complex, coexisting pathology.