Conventional or endovascular aortic repair for patients with cardiac and aortic pathologies?

A 62-year-old man with descending aorta aneurysm combined with cardiac pathologies was assessed as not suitable for conventional surgery and underwent endografting of the thoracoabdominal aorta. Shortly thereafter, he developed rapid progression of the aneurysm caused by a proximal leak. The patient underwent additional stenting of the left sub-clavian artery without success and because the aneurysm reached a diameter of 9.5 cm during the following 4 months and vascular surgeons saw no possibility for further reintervention, the patient was referred to our clinic to get a second opinion. He underwent successful surgery consisting of complete arch replacement with additional covering of the descending aorta using the elephant trunk technique as well as ligation and bypassing of the left sub-clavian artery. Concomitantly, repair of the mitral and tricuspid valves was performed.