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Mid- To Long- Term Outcomes Of Ascending Sliding Arch Aortoplasty Over 20 Years
Fumiya Yoneyama, Alyssa Kalustian, Jeffrey S. Heinle, Tam Doan, Ziyad Binsalamah.
Texas Children's Hospital, Houston, TX, USA.

Title:Mid- to Long-Term Outcomes of Ascending Sliding Arch Aortoplasty over 20 years
Objectives:Coarctation of the aorta is associated with significant hypoplasia of the aortic arch. Contrary to patch aortoplasty, ascending sliding arch aortoplasty utilizes viable autologous tissue in children for potential growth. This study reviews the mid- to long- term outcomes of this technique.
Methods:Between 2002 and 2023, 28 patients underwent ascending sliding arch aortoplasty for coarctation of the aorta. The median patient age and body weight were 28.5 months (3 weeks to 15.6 years) and 13.4kg (3.7 to 70kg), respectively. Preoperative echocardiography demonstrated that the median z-score of the distal transverse arch and isthmus was -2.4 (-6.9 to -0.1) and -2.8 (-5.1 to -0.1), respectively. The mean peak velocity was 3.90.6 m/sec, and pressure gradient was 63.621.5 mmHg.
Results:Although one case had a recurrent nerve injury postoperatively, there were no other major morbidities and mortality. Four cases underwent previous surgical coarctation repair in other institutions. The last follow-up echocardiography demonstrated that the mean peak velocity improved to 0.90.8 m/sec, and pressure gradient improved to 7.17.7 mmHg. The mean postoperative length of stay was 5.92.1 days, and the median survival period was 2700 (10 to 7516) days. There were no reoperations or catheterization based interventions for residual coarctation.
Conclusions:Ascending sliding arch aortoplasty is a safe and efficient technique for coarctation with arch hypoplasia. This technique is applicable in children ranging from neonates to adult-sized, recurrent coarctation cases, and provides complete relief of narrowing by utilizing viable native aortic tissue.


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