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Ascending-to-descending aortic grafting: an alternative approach for adults with complex aortic coarctation

Published online by Cambridge University Press:  22 September 2025

Polona Kacar Open the ORCID record for Polona Kacar [Opens in a new window] ,
Giulia Iannaccone ,
Pietro Paolo Tamborrino ,
Darryl Shore ,
Michael Murphy ,
Ulrich Rosendahl ,
Michael A. Gatzoulis  and
Claudia Montanaro
Polona Kacar*
Affiliation:
Adult Congenital Heart Disease Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
Giulia Iannaccone
Affiliation:
Adult Congenital Heart Disease Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Lazio, Italy
Pietro Paolo Tamborrino
Affiliation:
Adult Congenital Heart Disease Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK University of Pisa and Cardiovascular Division, Pisa University Hospital, Pisa, Italy
Darryl Shore
Affiliation:
Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK
Michael Murphy
Affiliation:
Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK
Ulrich Rosendahl
Affiliation:
Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK
Michael A. Gatzoulis
Affiliation:
Adult Congenital Heart Disease Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK
Claudia Montanaro
Affiliation:
Adult Congenital Heart Disease Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK
*
Corresponding author: Polona Kacar; Email: polona.kacar@kclj.si
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Abstract

Objective:

Contemporary management of aortic coarctation in adults is primarily by percutaneous intervention; however, this is not always possible. Intrapericardial ascending-to-descending aortic grafting is an alternative approach in adults with complex aortic coarctation. It can be performed off-pump and allows for a simultaneous treatment of concomitant cardiac lesions. Our aim was to examine the indications and the clinical long-term outcomes of intrapericardial ascending-to-descending aortic grafting in adults with aortic coarctation.

Methods:

We retrospectively reviewed demographic, clinical, surgical, and follow-up data of patients who underwent intrapericardial ascending-to-descending aortic grafting at a single tertiary centre between September 1994 and November 2016.

Results:

Ten patients were identified. Indications were primary intervention (n = 4), re-coarctation (n = 5), and iatrogenic coarctation of aorta after stent grafting (n = 1). There were no peri-operative deaths. During a mean follow-up of 13.6 ± 9.4 years, one patient died 11 years after surgery, unrelated to intrapericardial ascending-to-descending aortic grafting. All grafts remained patent with no anastomotic pseudoaneurysms at latest follow-up.

The mean systolic blood pressure decreased from 154 ± 24 mmHg at baseline to 134 ± 20 mmHg at latest follow-up (p = 0.05), with the mean number of prescribed antihypertensive medications decreasing from 2.8 ± 1.5 preoperatively to 1.6 ± 0.5 (p = 0.11).

Conclusion:

Intrapericardial ascending-to-descending aortic grafting is a safe and effective approach for adults with complex coarctation of aorta or re-coarctation not suitable for a percutaneous or conventional surgical approach. Improved blood pressure control and reduced anti-hypertensive use were observed long-term.

Keywords

Coarctation of aortare-coarctationsurgeryarterial hypertension

Information

Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 5
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© The Author(s), 2025. Published by Cambridge University Press

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