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Reoperative repair of adult aortic coarctation with explantation of thoracic stent-graft: a case report

Coarctation of the aorta (CoA) is a relatively common congenital cardiac abnormality. Most patients undergo operative intervention early in life, and up to half of these patients will require reintervention at some point. Here we report our technique for operative repair of an adult coarctation in a patient previously treated with open bypass and endovascular stenting. The patient is a 50-year-old man with a history of hypertension and aortic coarctation treated with extra-anatomic bypass at age 16 who subsequently developed stenosis of the bypass with hypertension at age 45 and underwent endovascular stenting of the coarctation in 2013. He presented to our clinic with worsening hypertension and imaging showing a large pseudoaneurysm of the descending thoracic aorta (DTA). The patient underwent open explantation of the prior bypass and thoracic stent via left thoracotomy, with resection of the coarctation and reconstruction with a 22-mm woven Dacron graft. Aorto-to-left-subclavian bypass was also performed with a 12-mm Dacron graft. The patient was discharged on postoperative day 6, and at 2-month follow up remained in excellent functional status. This case represents a unique presentation of coarctation in a patient who had undergone two prior interventions. An open approach was deemed the most appropriate option given the patients’ young age and failure of previous surgical measures and endovascular options. This case demonstrates that, when performed in a high-volume aortic center, explantation of a thoracic stent-graft with open repair of CoA can be safely performed with excellent outcomes.