# A 3-stage hybrid strategy for heart transplantation following ascending-to-descending aortic bypass grafting

## TL;DR

A new 3-step approach was used to safely perform heart transplantation in a patient with a complex aortic graft history.

## Contribution

A novel hybrid surgical strategy combining catheter-based and endovascular techniques for heart transplantation in a complex case.

## Key findings

- A catheter-based stent was used to address aortic coarctation.
- The extra-anatomic graft was endovascularly excluded before heart transplantation.
- Interdisciplinary collaboration enabled successful management of a high-risk case.

## Abstract

Cardiac reoperation after an extra-anatomic aortic bypass graft entails considerable risk due to the proximity of the graft to the sternum. In the case discussed here, a woman with 2 prior sternotomies and a retrosternal aortic bypass graft for a history of aortic coarctation presented with advanced dilated cardiomyopathy requiring heart transplantation. The patient was managed through a novel 3-stage hybrid strategy. In the first stage, a catheter-based approach was used to stent the coarcted aorta. Subsequently, the extra-anatomic graft was endovascularly excluded and, finally, the patient underwent reoperation for heart transplantation. The use of interdisciplinary collaboration for coordinated staging and shared decision-making, as in this case, allows for innovative solutions and improved outcomes in complex surgical needs.