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Moghaddam Shahri HM, Mortezaeian H, Firouzi A, Khajali Z, Birjandi H, Nezafati MH, Radmehr H, Zanjani KS. Safety of Aortic Coarctation Treatment in Patients with Turner Syndrome: A Single-Country Case Series and Literature Review. Ann Vasc Surg 2022; 85:292-298. [PMID: 35271967 DOI: 10.1016/j.avsg.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Coarctation of the aorta is a common cardiac disease in Turner syndrome. Evidence indicates that surgery and balloon angioplasty in infants and small children do not have any added risk of mortality or complication in these patients. Stenting in older patients may, however, pose higher risks of arterial wall injury and mortality. METHODS In this case series, we describe 15 patients with coarctation of the aorta in Turner syndrome: 9 received stenting, 4 underwent surgery, and 2 were treated via balloon angioplasty. RESULTS Dissection occurred in 2 patients after stenting: 1 in the aorta and the other in the external femoral artery. Both were managed promptly without any mortality or serious damage: 1 percutaneously and the other surgically. CONCLUSIONS Awareness of increased risks and preparedness for prompt interventions in case of an acute arterial wall injury are recommended when coarctation stenting is done for a patient with Turner syndrome.
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Affiliation(s)
| | | | - Ata Firouzi
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Hassan Birjandi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassan Nezafati
- Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Radmehr
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Sayadpour Zanjani
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. https://orcid.org/0000-0002-4640-4399
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2
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Stiller B, Zartner P, Dähnert I, Haas NA, Schubert S, Kanaan M, Berger F, Ewert P, Schmoor C, Grohmann J. Prospective multicenter study of the breakable babystent for treatment of aortic coarctation in newborns and infants. Catheter Cardiovasc Interv 2022; 99:1529-1537. [PMID: 35170186 DOI: 10.1002/ccd.30133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022]
Abstract
To assess the efficacy and safety of a breakable BabyStent to treat complex aortic coarctation (CoA) in early childhood. Although recommended in several guidelines, there is no approved aortic stent for young infants, because of the dilemma between two mandatory requirements: expandable up to adult size on the one hand, and small enough to fit through a baby's femoral artery on the other. Prospective interventional, multi-center clinical trial with the breakable Osypka BabyStent® (OBS). The OBS is a low-profile, 15-mm long cobalt-chromium stent, pre-mounted on a 6 mm balloon and inserted via a 4 Fr sheath. After implantation, its diameter is adjustable from 6 to 12 mm by balloon dilation. Further dilation opens predefined joints enabling unrestricted growth. Nineteen patients (9 male), median age 112 days (range: 7-539), median body weight 5.6 kg (range: 2.4-8.4) were deemed high risk and underwent stent implantation. Of those, 74% suffered from re-CoA following surgery, 53% had additional cardiac and 21% noncardiac malformations. Our primary combined endpoint was fulfilled: All stents were implanted in the desired region, and a >50% intrastenotic diameter-extension was achieved in 15 patients (78.9%, 80% confidence interval [62.2; 90.5], 95% confidence interval [54.4; 93.9]). Secondary endpoint confirmed that the OBS fits the baby's femoral vessel diameter. All children survived the procedure and 12-month follow-up. This stent enables percutaneous stenting of complex aortic coarctation to treat high-risk newborns and infants.
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Affiliation(s)
- Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Zartner
- Department of Pediatric Cardiology, Kinderherzzentrum am Universitätsklinikum, Bonn, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Heart Centre Leipzig, Helios Klinik GmbH, Leipzig, Germany
| | - Nikolaus A Haas
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Majed Kanaan
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre of the State of Bavaria and the Technical University, Munich, Germany.,German Center for Cardiovascular Research, Munich, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Alsallami AYA, Amber KI. Adult Aorta With Coarctation - One Year Follow Up. Med Arch 2021; 75:184-187. [PMID: 34483447 PMCID: PMC8385734 DOI: 10.5455/medarh.2021.75.184-187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/15/2021] [Indexed: 11/03/2022] Open
Abstract
Background Coarctation of the aorta (CoA), is a congenital disease in which the aorta is tightening, which occurs most commonly post to the ductus arteriosus. Also, coarctation can define as constriction of the aorta of different degrees that may occur at any part from the transverse arch of the aorta to iliac bifurcation but most commonly appear just below the beginning of the subclavian artery. Objective The aim of the study is to evaluate mortality and morbidity rate among patients use uncover stents in treating adult coarctation of the aorta and short-term outcomes. Methods During the period from February 2018 to February 2020 patients with aortic coarctation who is age above 16 years old have been selected to enter this study. Patients were selected from patients visiting adult cardiology consultation rooms in Najaf cardiac center or from private clinics visiting patient, at the end of two years only 75 patients with Coarctation of the aorta has the eligibility to enter this study. Results All patients stent by uncovering stent including for 2 cases with interrupted coarctation, immediately after stent pressure gradient fall to less than 10 mmHg in almost all our patient then follow up 6 months, 1 year by angiography assessment with CT chest shows no stent fracture or aneurysm in the aorta at the stent site. Conclusion Uncover stent appears to be safe in treating coarctation of the aorta with less morbidity and mortality.
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Laure Yammine M, Calvieri C, Chinali M, Giannico S, Cafiero G, Giordano U. Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up. CONGENIT HEART DIS 2021. [DOI: 10.32604/chd.2021.015896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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5
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Pan M, Ojeda S, Hidalgo F, Suárez de Lezo J, Lostalo A, Mazuelos F, Segura J, Pericet C, Luque A, González R, Fernández A, Gomez E, Romero M. Percutaneous reintervention on aortic coarctation stenting. EUROINTERVENTION 2020; 15:1464-1470. [DOI: 10.4244/eij-d-18-00923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stent Angioplasty for Critical Native Aortic Coarctation in Three Infants: Up to 15-Year Follow-Up Without Surgical Intervention and Review of the Literature. Pediatr Cardiol 2018; 39:1501-1513. [PMID: 29948027 DOI: 10.1007/s00246-018-1922-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 01/13/2023]
Abstract
Management of neonatal native coarctation is debated till now. Surgical therapy remains an option but may be unwarranted in critically sick infants with complex lesions. Balloon dilatation has been employed but with early re-stenosis. Stent angioplasty has also been used but as a bridge towards definitive surgical therapy. Four critically sick infants with complex coarctation and additional co-morbidity factors underwent primary stent therapy as surgical intervention was denied. One patient had died earlier due to reasons unrelated to the procedure. Three survivors underwent multiple dilatations of primary stents as indicated. One of the three survivors did not require any further dilatation after the age of 5 years and remained stable till the time of reporting. High-pressure Cheatham Platinum stents were implanted inside the primary stents in two infants, who developed re-stenosis due to somatic growth. These stents were further balloon dilated at high atmospheric pressure. Femoral arteries in both of them were blocked but were re-canalized after balloon dilatation in one and stent angioplasty in the other. After a follow-up of about 15 years, all of them have been doing fine with acceptable Doppler gradients. They were normotensive and on no cardiac medications. It can be concluded that, though surgical repair remains a standard of care, stent angioplasty in selected infants with complex lesions is feasible and effective. Multiple dilatations can be performed without added risk of stent migration. Bio-absorbable and growth stents hold a promise for future use in such situations.
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7
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Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience. Int J Cardiol 2018; 263:34-39. [DOI: 10.1016/j.ijcard.2018.02.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/13/2018] [Indexed: 11/20/2022]
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8
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Coarctation of the aorta-stenting via Glidesheath Slender in a newborn with recoarctation early after a Norwood operation. Cardiol Young 2018; 28:347-350. [PMID: 29081324 DOI: 10.1017/s1047951117001883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this article, we report on a newborn with hypoplastic left heart syndrome in whom recoarctation of the aorta was treated with a bare metal stent (Cook Formula 414 Stent) in the early postoperative period after a Norwood procedure. To reduce the risk for scarring and occluding the femoral artery the stent was implanted via 5F Glidesheath Slender sheath.
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Aldoss O, Goldstein BH, Danon S, Goreczny S, Gray RG, Sathanandam S, Whiteside W, Williams DA, Zampi JD. Acute and mid-term outcomes of stent implantation for recurrent coarctation of the aorta between the Norwood operation and fontan completion: A multi-center Pediatric Interventional Cardiology Early Career Society Investigation. Catheter Cardiovasc Interv 2017; 90:972-979. [DOI: 10.1002/ccd.27231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/20/2017] [Accepted: 07/16/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Osamah Aldoss
- University of Iowa Children's Hospital; Iowa city, Iowa
| | | | - Saar Danon
- St. Louis University; St. Louis, Missouri
| | | | | | | | - Wendy Whiteside
- Cincinnati Children's Hospital Medical Center; Cincinnati, Ohio
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Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol 2016; 16:75-96. [PMID: 27376865 DOI: 10.1007/s10237-016-0803-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/21/2016] [Indexed: 01/08/2023]
Abstract
Image-based computational fluid dynamics (CFD) studies conducted at rest have shown that atherosclerotic plaque in the thoracic aorta (TA) correlates with adverse wall shear stress (WSS), but there is a paucity of such data under elevated flow conditions. We developed a pedaling exercise protocol to obtain phase contrast magnetic resonance imaging (PC-MRI) blood flow measurements in the TA and brachiocephalic arteries during three-tiered supine pedaling at 130, 150, and 170 % of resting heart rate (HR), and relate these measurements to non-invasive tissue oxygen saturation [Formula: see text] acquired by near-infrared spectroscopy (NIRS) while conducting the same protocol. Local quantification of WSS indices by CFD revealed low time-averaged WSS on the outer curvature of the ascending aorta and the inner curvature of the descending aorta (dAo) that progressively increased with exercise, but that remained low on the anterior surface of brachiocephalic arteries. High oscillatory WSS observed on the inner curvature of the aorta persisted during exercise as well. Results suggest locally continuous exposure to potentially deleterious indices of WSS despite benefits of exercise. Linear relationships between flow distributions and tissue oxygen extraction calculated from [Formula: see text] were found between the left common carotid versus cerebral tissue [Formula: see text] and the dAo versus leg tissue [Formula: see text]. A resulting six-step procedure is presented to use NIRS data as a surrogate for exercise PC-MRI when setting boundary conditions for future CFD studies of the TA under simulated exercise conditions. Relationships and ensemble-averaged PC-MRI inflow waveforms are provided in an online repository for this purpose.
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Suárez de Lezo J, Romero M, Pan M, Suárez de Lezo J, Segura J, Ojeda S, Pavlovic D, Mazuelos F, López Aguilera J, Espejo Perez S. Stent Repair for Complex Coarctation of Aorta. JACC Cardiovasc Interv 2016; 8:1368-1379. [PMID: 26315741 DOI: 10.1016/j.jcin.2015.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/13/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to determine whether several anatomic or evolving characteristics of the coarctation may create challenging conditions for treatment. BACKGROUND Stent repair of coarctation of aorta is an alternative to surgical correction. METHODS We analyzed our 21-year experience in the percutaneous treatment of complex coarctation of aorta. Adverse conditions for treatment were as follow: 1) complete interruption of the aortic arch (n = 11); 2) associated aneurysm (n = 18); 3) complex stenosis (n = 30); and 4) the need for re-expansion and/or restenting (n = 21). Twenty patients (33%) belonged to more than 1 group. Ten interruptions were type A and 1 was type B. The mean length of the interrupted aorta was 9 ± 11 mm. The associated aneurysms were native in 8 patients and after previous intervention in 10 patients. Aneurysm shapes were fusiform in 8 patients and saccular in 10. The following characteristics defined complex stenosis as long diffuse stenosis, very tortuous coarctation, or stenosis involving a main branch or an unusual location. Patients previously stented at an early age, required re-expansion and/or restenting after reaching 16 ± 5 years of age. RESULTS Two patients had died by 1-month follow-up. The remaining 58 patients did well and were followed-up for a mean period of 10 ± 6 years. Late adverse events occurred in 3 patients (5%). All remaining patients are symptom-free, with normal baseline blood pressure. Imaging techniques revealed good patency at follow-up without associated aneurysm or restenosis. The actuarial survival free probability of all complex patients at 15 years was 92%. CONCLUSIONS Stent repair of complex coarctation of aorta is feasible and safe. Initial results are maintained at later follow-up.
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Affiliation(s)
- José Suárez de Lezo
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain.
| | - Miguel Romero
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Manuel Pan
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Javier Suárez de Lezo
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - José Segura
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Djordje Pavlovic
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Francisco Mazuelos
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - José López Aguilera
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Simona Espejo Perez
- Department of Radiology, Reina Sofia University Hospital, University of Córdoba and IMIBIC, Córdoba, Spain
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Grohmann J, Sigler M, Siepe M, Stiller B. A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience. Catheter Cardiovasc Interv 2016; 87:E143-50. [DOI: 10.1002/ccd.26393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/14/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care; University Hospital Göttingen; Göttingen Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery; Heart Center, University of Freiburg; Freiburg Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
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13
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Tretter JT, Jones TK, McElhinney DB. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation. Circ Cardiovasc Interv 2015; 8:e002840. [DOI: 10.1161/circinterventions.115.002840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Justin T. Tretter
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
| | - Thomas K. Jones
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
| | - Doff B. McElhinney
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
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Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R. Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation 2015; 131:1656-64. [PMID: 25869198 DOI: 10.1161/circulationaha.114.013937] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/05/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Coarctation of the Aorta Stent Trial (COAST) was designed to assess the safety and efficacy of the Cheatham Platinum stent when used in children and adults with native or recurrent coarctation. Acute outcomes have been reported. We report here follow-up to 2 years. METHODS AND RESULTS A total of 105 patients underwent attempted implantation, with 104 successes. There were no procedural deaths, serious adverse events, or surgical intervention. All patients experienced immediate reduction in upper- to lower-extremity blood pressure difference with sustained improvement to 2 years. Rates of hypertension and medication use decreased from baseline to 12 months and remained largely unchanged at 2 years. Six aortic aneurysms have been identified: 5 were successfully treated with covered stent placement, and 1 resolved without intervention. Stent fractures were noted in 2 patients at 1 year and 11 patients at 2 years, with evidence of fracture progression. To date, only larger stent diameter was associated with stent fracture. Twelve additional fractures have occurred after 2 years. No fracture has resulted in loss of stent integrity, stent embolization, aortic wall injury, or reobstruction. Nine reinterventions occurred in the first 2 years for stent redilation and address of aneurysms, and 10 additional reinterventions occurred after 2 years. CONCLUSIONS The Cheatham Platinum stent is safe and associated with persistent relief of aortic obstruction. Stent fracture and progression of fracture occur but have not resulted in clinically important sequelae. Reintervention is common and related to early and late aortic wall injury and need for re-expansion of small-diameter stents. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00552812.
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Affiliation(s)
- Jeffery Meadows
- From Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco (J.M.); Department of Cardiology, Boston Children's Hospital, MA (M.M., K.M.); Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA (D.B.M.); and Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (R.R.).
| | - Matthew Minahan
- From Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco (J.M.); Department of Cardiology, Boston Children's Hospital, MA (M.M., K.M.); Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA (D.B.M.); and Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (R.R.)
| | - Doff B McElhinney
- From Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco (J.M.); Department of Cardiology, Boston Children's Hospital, MA (M.M., K.M.); Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA (D.B.M.); and Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (R.R.)
| | - Kerry McEnaney
- From Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco (J.M.); Department of Cardiology, Boston Children's Hospital, MA (M.M., K.M.); Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA (D.B.M.); and Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (R.R.)
| | - Richard Ringel
- From Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco (J.M.); Department of Cardiology, Boston Children's Hospital, MA (M.M., K.M.); Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA (D.B.M.); and Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (R.R.)
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Ovaert C, Luciano D, Gaudart J, Boulogne O, Assaidi A, Kammache I, Fraisse A. The VALEO® vascular stent for cardiovascular lesions in children. EUROINTERVENTION 2015; 10:1326-31. [DOI: 10.4244/eijy15m01_09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Kudumula V, Noonan P, Taliotis D, Duke C. Implantation and preliminary follow-up of the Bard Valeo stent in pulmonary artery stenosis. Catheter Cardiovasc Interv 2014; 84:197-203. [DOI: 10.1002/ccd.25443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/03/2014] [Accepted: 02/08/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Vikram Kudumula
- East Midlands Congenital Heart Centre; Glenfield Hospital; Groby Road Leicester LE3 9QP United Kingdom
| | - Patrick Noonan
- Department of Paediatric Cardiology; Royal Hospital for Sick Children; Dalnair Street Yorkhill Glasgow G3 8SJ United Kingdom
| | - Demetris Taliotis
- East Midlands Congenital Heart Centre; Glenfield Hospital; Groby Road Leicester LE3 9QP United Kingdom
| | - Christopher Duke
- East Midlands Congenital Heart Centre; Glenfield Hospital; Groby Road Leicester LE3 9QP United Kingdom
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17
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Feng Q, Jiang W, Sun K, Sun K, Chen S, Zhao L, Dai K, Ma N. Mechanical properties and in vivo performance of a novel sliding-lock bioabsorbable poly-p-dioxanone stent. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2319-2327. [PMID: 21822666 DOI: 10.1007/s10856-011-4407-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
A bioabsorbable poly-p-dioxanone (PPDO) stent with a novel sliding-lock structure was fabricated to treat stenotic peripheral vessels. The sliding-lock PPDO stents have greater radial strength (107 kPa) than PPDO stents with conventional net-tube structure (32 kPa). The sliding-lock PPDO stents were implanted into the iliac arteries of pigs, and implantation success rate was 90% indicating the feasibility of this design. Additionally, we found that sliding-lock PPDO stents kept vessels patent, although by 3 and 6 months post implantation, luminal diameter decreased slightly due to intimal hyperplasia. At 1 month post implantation, the stents were sparsely covered with endothelial cells, and by 6 months, the stents were mostly absorbed and inflammatory reaction gradually decreased as the stents were absorbed. This study shows favorable mechanical strength, degradability and efficacy for the sliding-lock PPDO stents, and supports further research and development of this unique design of polymer stents for applications in vascular devices.
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Affiliation(s)
- Qimao Feng
- Children's Heart Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
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Zanjani KS, Thanopoulos BD, Peirone A, Alday L, Giannakoulas G. Usefulness of stenting in aortic coarctation in patients with the Turner syndrome. Am J Cardiol 2010; 106:1327-31. [PMID: 21029833 DOI: 10.1016/j.amjcard.2010.06.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 11/29/2022]
Abstract
We report our experience with stent implantation for treatment of aortic coarctation in patients with Turner syndrome. Ten consecutive patients with Turner syndrome and aortic coarctation (median age 12 years, range 9 to 24) underwent coarctation stenting. Of these, 6 patients were treated for isolated coarctation and 4 for recurrent coarctation (3 after balloon dilation and 1 after balloon dilation and surgical repair). Bare metal stents were implanted in 7 patients and covered stents in 3. Immediately after stent implantation, peak systolic gradient decreased from 46.1 ± 24.3 to 1.9 ± 2.1 mm Hg (p <0.001). Aortic diameter at coarctation site increased from 5.1 ± 3.2 to 15.3 ± 2.0 mm after stenting (p <0.001). There were no deaths or procedure-related complications. During a median follow-up of 30.5 months, no patient developed restenosis. Two patients developed late aortic aneurysms at the coarctation site. In conclusion, stent implantation for aortic coarctation in patients with Turner syndrome appears to be a safe and effective alternative to surgical repair. Larger cohorts and longer-term follow-up are required to determine the effects of the procedure on the aortic wall.
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Affiliation(s)
- Keyhan Sayadpour Zanjani
- Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Iran
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Hraška V, Walters HL. Management of Complete Atrioventricular Canal Defect With Aortic Arch Obstruction. World J Pediatr Congenit Heart Surg 2010; 1:199-205. [DOI: 10.1177/2150135110371136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with complete atrioventricular canal defect and aortic arch obstruction represent a particular challenge for management. The incidence is rare, so surgical experience is limited. A reasonable treatment option for newborns and young infants with competent atrioventricular valves is the staged approach, with the arch obstruction repaired first, followed at an appropriate interval by repair of the complete atrioventricular canal defect. If there is a significant degree of atrioventricular valve regurgitation, the primary single-stage correction of both aortic arch obstruction and the intracardiac malformation should be undertaken, irrespective of age. It remains to be seen whether this surgical strategy can be adopted for the entire spectrum of atrioventricular canal defect associated with arch obstruction.
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Affiliation(s)
- Viktor Hraška
- German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Germany
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Rao PS. Transcatheter interventions in critically ill neonates and infants with aortic coarctation. Ann Pediatr Cardiol 2009; 2:116-9. [PMID: 20808623 PMCID: PMC2922658 DOI: 10.4103/0974-2069.58312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- P Syamasundar Rao
- Address for correspondence: Dr. P Syamasundar Rao, Division of Pediatric Cardiology, The University of Texas/Houston Medical School, 6410 Fannin Street, UTPB Suite # 425, Houston, TX 77030, USA. E-mail:
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Peters B, Ewert P, Berger F. The role of stents in the treatment of congenital heart disease: Current status and future perspectives. Ann Pediatr Cardiol 2009; 2:3-23. [PMID: 20300265 PMCID: PMC2840765 DOI: 10.4103/0974-2069.52802] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of "modern" stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the "ideal stent" has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.
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Affiliation(s)
- Bjoern Peters
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
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