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Salavitabar A, Eisner M, Armstrong AK, Boe BA, Chisolm JL, Cheatham JP, Cheatham SL, Forbes T, Jones TK, Krings GJ, Morray BH, Steinberg ZL, Akam-Venkata J, Voskuil M, Berman DP. Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study. Circ Cardiovasc Interv 2024; 17:e013729. [PMID: 38666384 DOI: 10.1161/circinterventions.123.013729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction. METHODS This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed. RESULTS Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (P=0.018), body surface area (P=0.013), and minimum-to-descending aortic diameter ratio (P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio. CONCLUSIONS Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
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Affiliation(s)
- Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH (M.E.)
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Brian A Boe
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Joanne L Chisolm
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Sharon L Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Thomas Forbes
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Thomas K Jones
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital of the University Medical Center Utrecht, the Netherlands (G.J.K.)
| | - Brian H Morray
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
| | - Zachary L Steinberg
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
- Department of Medicine, Division of Cardiology, University of Washington, Seattle (Z.L.S.)
| | - Jyothsna Akam-Venkata
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (M.V.)
| | - Darren P Berman
- Heart Institute, Children's Hospital Los Angeles, CA (D.P.B.)
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Ahmadi A, Mansourian M, Sabri MR, Ghaderian M, Karimi R, Roustazadeh R. Follow-up outcomes and effectiveness of stent implantation for aortic coarctation: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102513. [PMID: 38556144 DOI: 10.1016/j.cpcardiol.2024.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The authors aim to investigate the clinical implications of stent use for the management of CoA. METHODS All observational studies on stent implantation for the treatment of aortic coarctation and the relevant RCTs were systematically retrieved. Outcomes included the immediate success rate, pre- and post-stent gradient, survival, minor and major complications, restenosis, post-stent systolic blood pressure, and reintervention rate. The analysis was further stratified by CoA type, stent type, and the mean age of the patients. RESULTS Our meta-analysis incorporated 66 eligible studies involving 3,880 patients. The success rates for stent placement, defined as achieving post-treatment gradients of ≤20 mmHg and 10 mmHg, 0.96 (95% CI: 0.95 - 0.97; I2 = 59.83%) and 0.92 (95% CI: 0.89 - 0.95, I2 = 77.63%) respectively. The complication rates were quite low, with minor and major complication rates of 0.017 (95% CI: 0.013 - 0.021) and 0.007 (95% CI: 0.005 - 0.009), respectively. Unplanned reinterventions were required at a rate of 0.021 (95% CI: 0.015 - 0.026). At a mean follow-up of 2.9 years, 97% of the patients survived and 28% remained on antihypertensive therapy. While immediate effectiveness was consistent across age groups, complications were more prevalent in patients aged <20 years, and long-term efficacy was lower in those aged >20 years. Encouragingly, in neonates and infants, CoA stenting yielded results comparable to those observed in older children. CONCLUSION These findings underscore the overall favorable outcomes of stent placement for aortic coarctation, with considerations for age-related variations in complications and long-term efficacy.
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Affiliation(s)
- Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Karimi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roshanak Roustazadeh
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Demir İH, Kardas M, Yucel İK, Yekeler Rİ, Bulut MO, Hekim Yılmaz E, Sürücü M, Epçaçan S, Celebi A. Transverse arch stenting and its effect on systemic hypertension. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:151-161. [PMID: 38933307 PMCID: PMC11197410 DOI: 10.5606/tgkdc.dergisi.2024.25931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 06/28/2024]
Abstract
Background This study aimed to investigate the safety and efficacy of transverse aortic arch stenting and evaluate the course of hypertension and the act of arch stenting on systemic hypertension. Methods The transverse aortic arch stenting procedures between January 2007 and May 2023 were retrospectively analyzed. Detailed procedure information, technical aspects, pressure measurements, angiographic data, balloons and stents used, complications, and immediate results were examined. Early and mid-term results were assessed. Results Eighteen patients (10 males and 8 females; mean age: 14.5±5.3 years; range, 4 to 23 years) were included in the study, all of whom were hypertensive before the procedure. The mean weight was 56.8±19.6 kg. In seven patients, the stent struts had to be dilated due to the stent causing jailing at the entrance of nearby arch vessels. After stenting, there was a significant increase in arch diameter and a decrease in ascending aorta pressure and the pressure gradient across the aorta. There were no early mortality or major complications. Late migration of the stent was observed in one patient. Three patients became normotensive immediately after the intervention, and five became drug-free during the follow-up. The requirement for dual antihypertensive therapy was significantly reduced. Conclusion Residual transverse arch lesions may contribute to the persistence of systemic hypertension after coarctation treatment. Transverse arch stent implantation can be performed safely with favorable outcomes, facilitating better blood pressure control. However, it should be noted that these patients remain at risk for lifelong hypertension and should be closely monitored in this regard.
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Affiliation(s)
- İbrahim Halil Demir
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Kardas
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - İlker Kemal Yucel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Rukiye İrem Yekeler
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Emine Hekim Yılmaz
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Sürücü
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Serdar Epçaçan
- Department of Pediatric Cardiology, Van Training and Research Hospital, Van, Türkiye
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
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Abstract
PURPOSE OF REVIEW Coarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. RECENT FINDINGS Recent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention.New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention. SUMMARY Optimizing aortic arch size, prevention and aggressive treatment of hypertension and vascular stiffening are important to improve long-term outcomes.
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