Surgical technique challenges in adult aortic coarctation patients: A case series

INTRODUCTION AND IMPORTANCE: Aortic coarctation (CoA) is relatively rare in adult patients and often presents with non-specific symptoms. It typically results from either delayed recognition or residual lesion following incomplete repair in childhood. While concomitant cardiac abnormalities are commonly detected in children, adult patients more often present with isolated CoA or complications resulting from late diagnosis. Untreated CoA can lead to significant long-term complications, including refractory hypertension, heart failure, and aortic aneurysm or rupture. CASE SERIES: We present a case series of three adult patients with CoA of varying severity and associated cardiac pathologies. Each patient underwent a different open surgical approach. First, a 39-year-old male presented with recurrent CoA with severe adhesions. Second, a 48-year-old male presented with proximal descending CoA accompanied by ascending aortic aneurysm and severe aortic stenosis. Third, a 25-year-old male presented with CoA and severe aortic valve insufficiency. All patients were diagnosed with CoA via echocardiography and underwent surgical procedures. DISCUSSION: Managing adult CoA, particularly when combined with other cardiac pathologies, poses significant surgical challenges due to the lack of standardized guidelines for such complex conditions. Surgeons must make critical decisions regarding the order of repairs, the selection of the most suitable surgical approach, and the ideal timing of intervention to ensure patient safety. CONCLUSION: Surgical approaches for CoA are individualized based on the complexity of the coarctation and associated cardiac pathologies. Surgical management of CoA either in adults or neonates should be performed accurately and effectively to reduce morbidity and long-term complications.