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Sherif NEE, Taggart NW. Covered Stents in the Management of Aortic Coarctation and Right Ventricular Outflow Tract Obstruction. Curr Cardiol Rep 2022; 24:51-58. [PMID: 35028814 DOI: 10.1007/s11886-021-01623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To review the use of covered stents in the treatment of coarctation of the aorta (CoA) and right ventricle to pulmonary artery (RV-PA) conduit obstruction. RECENT FINDINGS The only commercially available covered stent approved for treatment of CoA and dysfunctional RV-PA conduits is the covered Cheatham-Platinum stent (CCPS). Early outcomes have demonstrated its safety and have suggested its efficacy in treating or preventing aortic wall injury (AWI) or conduit disruption. A recent study of CCPS use for CoA reported a progressive risk of stent fracture over time and a risk of AWI despite the purported protection that the CCPS provides. The use of other covered stents has been reported, but large, systematic studies are lacking. CCPS use may reduce but does not eliminate the risk of conduit disruption or AWI. Structural limitations of the CCPS may predispose it to stent fracture. Access to a broad range of covered stents continues to be an unmet need in the field of congenital interventional cardiology.
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Affiliation(s)
- Nibras E El Sherif
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Boe BA, Armstrong AK, Janse SA, Loccoh EC, Stockmaster K, Holzer RJ, Cheatham SL, Cheatham JP, Berman DP. Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg: A 12-Year Experience. Circ Cardiovasc Interv 2021; 14:e009399. [PMID: 33544625 DOI: 10.1161/circinterventions.120.009399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients. METHODS A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed. RESULTS Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3-7.9) years and 10 (5.5-20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18-42] to 0 mm Hg [IQR, 0-2]; P< 0.05) and median minimum diameter (3.6 mm [IQR, 2.4-4.8] to 7.7 mm [IQR, 6.5-9.4]; P<0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5-63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8-116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion. CONCLUSIONS Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.
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Affiliation(s)
- Brian A Boe
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Aimee K Armstrong
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Sarah A Janse
- Center for Biostatistics Department of Biomedical Informatics, The Ohio State University, Columbus (S.A.J.)
| | - Eméfah C Loccoh
- The Ohio State University College of Medicine, Columbus (E.C.L.)
| | - Katie Stockmaster
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Ralf J Holzer
- Department of Pediatrics, Weill Cornell Medical College, New York, NY (R.J.H.)
| | - Sharon L Cheatham
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - John P Cheatham
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Darren P Berman
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
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