Is endovascular repair for patients with primary adult coarctation, bicuspid aortic valve, dilated ascending aorta and hypertension the new gold standard?

We readwith great interest the recent article byWheatley III Grayson et al. on the safety and effectiveness of endovascular repair for primary adult coarctation (PAAC) as an alternative to surgical repair [1]. They report excellent early and midterm results on 16 adult patients with PAAC treated with endovascular repair. The study group included three (18.7%) PAAC patients associated with bicuspid aortic valve, dilated ascending aorta and hypertension; two other (12.5%) PAAC patients are affected by hypertension and dilated ascending aorta. We have treated, as ‘others’ group, PAAC patients associated with cardiovascular disorders with one-stage surgical procedure: repair of aortic coarctation by ascending—descending posterior pericardial bypass and the associated disorders by specific surgical treatment [2,3]. Intermediate term (mean follow-up of 40 months) has shown that this one-stage surgical approach is safe and effective [4]. Patients with bicuspid aortic valve, dilated ascending aorta and hypertension are at higher risk for aortic dissection; moreover, the association of PAAC and the previously cited cardiovascular co-morbidities outlines an inherent aortic disorder [5]. Do the authors believe that, for their young group of patients (mean age 39.7 years) with PAAC, bicuspid aortic valve, dilated ascending aorta and hypertension, a singlestage surgical repair should be an alternative for the ultimate treatment of the all aortic pathologies?