Complex hybrid management of severe aortic stenosis and aortic arch disease in a nonagenarian: a case report

Background: Nonagenarians represent a cohort of patients at high or prohibitive risk in case of complex aortic procedures. A hybrid approach could reduce the surgical risk compared with a conventional surgery when performed at the age of 90. Case summary: We reported the case of a 90-year-old man who presented with a progressive aortic arch dilatation due to a persistent type-1A endoleak following previous thoracic endovascular aortic repair due to type-B aortic dissection. The aortic computed tomography scan confirmed a 65 × 67 mm aortic arch dilatation due to a type-1A endoleak and a transthoracic echocardiogram showed a severe aortic valve stenosis. On full sternotomy and partial cardiopulmonary bypass assistance, the patient underwent transcatheter aortic valve replacement combined with surgical brachiocephalic trunk and left common carotid artery debranching and thoracic endovascular aortic repair of the aortic arch. The postoperative course was uneventful and the patient was discharged home at postoperative day 15. Discussion: The described hybrid procedure lessened the prohibitive risks that could have been related to a conventional open aortic arch surgery in nonagenarians.