Surgical Management of Ascending Aortic and Innominate Artery Pathology Following Previous Aortic Valve Replacement: A Redo Sternotomy Case Report

Background: Progressive dilation of the ascending aorta after aortic valve replacement (AVR) is increasingly recognized and may coexist with aneurysms of supra-aortic vessels such as the innominate artery. Concomitant pathology in the ascending aorta and innominate artery presents complex technical challenges, particularly in a redo sternotomy setting. Case presentation: We describe a 30-year-old male with prior mechanical AVR who was incidentally found on routine imaging to have a dilated ascending aorta with a saccular aneurysm of the innominate artery. After multidisciplinary evaluation, he underwent elective redo median sternotomy with ascending aorta and hemiarch replacement and re-implantation/reconstruction of the innominate artery. Cerebral protection strategies and meticulous surgical technique were used. The postoperative course was uneventful; the patient was extubated on day 1, ambulated on day 2 and discharged in stable condition with preserved neurological function. Conclusion: With careful preoperative planning, cerebral protection, and experienced surgical execution, redo sternotomy with hemiarch replacement and innominate artery reconstruction can be carried out safely in selected patients. Vigilant imaging surveillance after AVR permits elective intervention prior to emergent complications. Keywords: Ascending aortic aneurysm, Innominate artery aneurysm, Redo sternotomy, Hemiarch replacement, Cerebral protection, Aortic valve replacement