Key result
A staged hybrid approach comprising valve-sparing aortic root replacement followed by TEVAR resulted in an uneventful recovery and optimal surgical outcome at 3 months in a 33-year-old female.
Why the study?
The management of coarctation of the aorta associated with additional congenital heart defects or acquired cardiovascular pathology in adults necessitates a comprehensive, individualized strategy.
Case Report (n=1)
A staged hybrid approach combining the David procedure and TEVAR is a feasible and effective strategy for complex adult congenital heart disease involving aortic coarctation, root aneurysm, and bicuspid aortic valve.
Supports feasibility of staged hybrid aortic repair in select adult congenital cases; leaves open need for larger series before broader consideration.
Coarctation of the aorta (CoA) is a congenital heart disease (CHD) that may remain undiagnosed until adulthood. Its clinical manifestations vary depending on the anatomical severity of the narrowing and the degree of collateral circulation development. The management of CoA, particularly when associated with additional CHDs or acquired cardiovascular pathology in adult patients, necessitates a comprehensive and individualised treatment strategy. We present a clinical case of a 33-year-old female diagnosed with CoA, complicated by an aortic root aneurysm and bicuspid aortic valve (BAV) insufficiency. Given the complexity of her condition, a staged hybrid approach was implemented. In the first stage, the patient underwent surgical valve-sparing aortic root replacement (David procedure), preserving the native valve function. Three weeks later, thoracic endovascular aortic repair (TEVAR) was performed to address the CoA. The patient's postoperative recovery was uneventful. Follow-up imaging, including computed tomography angiography (СТА) and transthoracic echocardiography at 3 months post-discharge, demonstrated an optimal surgical outcome, confirming the efficacy of this tailored two-stage strategy.
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Tolegenuly et al. (2025) conducted a case report in Coarctation of the aorta, aortic root aneurysm, and bicuspid aortic valve insufficiency (n=1). Staged hybrid approach (valve-sparing aortic root replacement followed by TEVAR) was evaluated on Surgical outcome and postoperative recovery. A staged hybrid approach comprising valve-sparing aortic root replacement followed by TEVAR resulted in an uneventful recovery and optimal surgical outcome at 3 months in a 33-year-old female.
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