Progressive Stenosis of Thoraflex Hybrid Prosthesis after Total Arch Replacement Leading to a Fatal Outcome: A Case Report

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The Thoraflex Hybrid prosthesis (Terumo Aortic, Inchinnan, UK) is widely used for total arch replacement, but postoperative stenosis or pseudo-coarctation is rare and potentially fatal. We report an 83-year-old man who underwent a Bentall procedure and total arch replacement with a 36-mm Thoraflex Hybrid graft (Terumo Aortic). Postoperative imaging showed mild stenosis, but distal perfusion was maintained. Eighteen hours later, his cardiac index dropped to 1.4 L/min/m² and lactate rose to 11.2 mmol/L. Computed tomography (CT) revealed severe graft stenosis. Although rescue thoracic endovascular aortic repair (TEVAR) transiently improved hemodynamics, the patient succumbed to multiorgan failure despite veno-arterial extracorporeal membrane oxygenation (VA ECMO). This case underscores the need for early recognition and prompt intervention.