Shared Decision-Making-Guided Prehabilitation for High-Risk Anomalous Aortic Origin of the Left Coronary Artery.

OBJECTIVE: To describe shared decision-making-guided prehabilitation as a bridge to repair in unrepaired high-risk anomalous aortic origin of the left main coronary artery. KEY STEPS: A young woman developed cardiogenic shock after hysteroscopic hemorrhage, required extracorporeal membrane oxygenation, and was found to have severe ostial compression of an anomalous left main coronary artery. After initial weaning, oral feeding was followed by recurrent shock requiring renewed support. Because repair was deferred for ventricular dysfunction, malnutrition, frailty, and emotional distress, she underwent 20 days of multidisciplinary prehabilitation capped at 2-3 METs after circulatory support was withdrawn. POTENTIAL PITFALLS: Feeding and exercise may become hemodynamic stressors; resting echocardiography cannot exclude exercise-induced compression. Premature ventricular contractions during cycling required activity cessation and reassessment. TAKE-HOME MESSAGE: Cautious monitored prehabilitation may bridge selected frail patients with unrepaired high-risk coronary anomaly to definitive repair.