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Mortezaeian H, Rezanejad E, Pasebani Y, Zamani R, Khalili Y, Ghaemi H, Jafari F, Sabri M, Moosavi J, Mohebbi B, Abdi A, Montazeri Namin S, Sadeghipour P, Haulon S, Fraisse A. Five-Year Outcomes of Coarctoplasty with Stents in the Pediatric Population: Results from a Retrospective Single-Center Cohort with Centrally Adjudicated Outcomes. Pediatr Cardiol 2024:10.1007/s00246-024-03551-4. [PMID: 38940826 DOI: 10.1007/s00246-024-03551-4] [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] [Received: 04/22/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to long-term outcomes are limited. The aim of this study was to evaluate the mid-term safety and efficacy of transcatheter CoA stenting based on centrally adjudicated outcomes. This retrospective cohort study included patients aged 15 years or younger undergoing de novo stenting for CoA or recoarctation (reCoA) between 2006 and 2017. Immediate and 5-year outcomes were assessed. Immediate outcomes (procedural and in-hospital) were retrieved from electronic records. Rates of 5-year reCoA, stent fractures, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were mid-term outcomes. The study included 274 patients (64% male and 36% female) with a median (interquartile range) age of 9 (6-12) years. Procedural success was achieved in 251 patients (91.6%). Procedural complications occurred in 4 patients (1.4%), consisting of stent migration in 1 (0.3%) and small non-expanding non-flow-limiting aortic wall injuries in 3 (1.1%). Major vascular access complications were observed in 18 patients (6.6%), acute limb ischemia in 8 (2.9%). In-hospital mortality occurred in 4 patients (1.4%). Five-year cumulative incidence rates of stent fractures, reCoA, and aortic aneurysmal/pseudoaneurysmal formation were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Of 73 reCoAs, 47 were treated with balloon angioplasty, and 15 underwent a second stent implantation. Five-year all-cause mortality occurred in 4/251 (1.6%) patients. Coarctoplasty with stents was safe and effective in our pediatric population during a 5-year follow-up despite a high rate of reCoA.
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Affiliation(s)
- Hojjat Mortezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Elham Rezanejad
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Yeganeh Pasebani
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Raheleh Zamani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Hamidreza Ghaemi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Farshad Jafari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Mahshad Sabri
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Jamal Moosavi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Bahram Mohebbi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Amir Abdi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Sara Montazeri Namin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Parham Sadeghipour
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran.
| | - Stephan Haulon
- Aortic Centre, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, SW3 6NP, UK
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Pan M, Pericet C, González-Manzanares R, Díaz MA, Suárez de Lezo J, Hidalgo F, Alvarado M, Dueñas G, Gómez E, Espejo S, Perea J, Romero M, Ojeda S. Very long-term follow-up after aortic stenting for coarctation of the aorta. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:332-341. [PMID: 37981191 DOI: 10.1016/j.rec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.
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Affiliation(s)
- Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Cristina Pericet
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Manuel A Díaz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Javier Suárez de Lezo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Marco Alvarado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Guillermo Dueñas
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Elena Gómez
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Simona Espejo
- Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jorge Perea
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
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Alsallami AYA, Amber K. Blood Pressure Behavior After Correction Adult Coarctation of Aorta Short Term Follows Up. Med Arch 2021; 75:269-273. [PMID: 34759446 PMCID: PMC8563032 DOI: 10.5455/medarh.2021.75.269-273] [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: 06/18/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
Background Coarctation of aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. Usually, untreated CoA may lead to a renal, vascular and cardiac complication that starts to appear at beginning of the fourth decade of life. Several methods have been proved as a modality for the treatment of CoA like balloon dilation, stenting, and surgery, etc. Objective To assess the hypertensive condition after endovascular stenting adult with CoA in short term follow up. Methods We report the outcome in 75 patients, out of these 30 male patients (40%) and 45 female patients (60%) were involved in this prospective longitudinal study, their age range between 16 to 41 years. Stenting of simple coarctation was performed on 75 patients at the Cardiology consult department in Al-najaf cardiac center or from a private clinic between January 2018 to January 2019. For the treatment of all patients, echocardiography, CT chest done to confirm diagnosis then all undergo catheterization of aorta with two sheaths one femoral and other radial to measure pressure gradient across the stenosis and stent localization follow by stenting with pre and post-dilation if needed then measure pressure gradient across stent. Results Out of 75 patients 69 patients (92%) returned for the 6-month follow-up evaluation and 53 patients (70%) returns for the 1-year follow-up evaluation with stent implantation, interrupted coarctation immediately after stent pressure gradient falls in almost all our patient. The patient returns at the time of 6 months and one year follow up, the assessment was done through CT angiography. At the time of six months, 39/69 patients (52%) and at the time of 1 year 18/45 patients (24%) show no aortic wall injury or aneurysm development. Conclusion Uncovered stents appear to be safe in treating CoA with less morbidity and mortality. Stent adult with CoA hasthe advantage of lowering blood pressure in those suffering from hypertension.
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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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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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Immediate results of percutaneous management of coarctation of the aorta: A 7-year single-centre experience. Int J Cardiol 2020; 322:103-106. [PMID: 32800905 DOI: 10.1016/j.ijcard.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coarctation of the aorta (CoA) is often treated percutaneously. The aim of this study was to describe the immediate results of percutaneous management of native aortic coarctation (NaCoA) and recoarctation of the aorta (ReCoA) at our institution. METHODS We identified all patients with NaCoA or ReCoA who underwent percutaneous dilatation by either balloon angioplasty (BAP) or endovascular stent implantation (ESI) between 2011 and 2017. Success was defined as a residual peak-to-peak gradient (PPG) <20 mmHg or a ≥50% reduction in the gradient if the pre-intervention PPG was <20 mmHg. RESULTS 63 patients (median age 6.8 years, interquartile range [IQR] 0.4-14.2) were identified. Among 11 patients with NaCoA, 7 underwent BAP and 4 had ESI, and among 52 patients with ReCoA, 42 underwent BAP and 10 had ESI. In patients with NaCoA, BAP was successful in 71%, with median PPG decreasing from 32 mmHg (IQR 25-46) to 17 mmHg (IQR 4-23) (p = .02), and ESI was successful in 100%, with median PPG decreasing from 20 mmHg (IQR 14.5-40) to 2 mmHg (IQR 0-6) (p < .01). In patients with ReCoA, BAP was successful in 69%, with median PPG decreasing from 20 mmHg (IQR 16-31.3) to 9 mmHg (IQR 0-14.3) (p < .001), and ESI was successful in 100%, with median PPG decreasing from 18 mmHg (IQR 11.5-22.8) to 0 mmHg (IQR 0-3.5) (p < .01). ESI was more successful than BAP (p = .01). There was only one complication. CONCLUSIONS Percutaneous management of CoA is safe and effective in both NaCoA and ReCoA. Stent implantation is more effective than BAP.
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Abstract
Percutaneous treatment of aortic coarctation is based on angioplasty and/or stenting of the isthmus. We report a case of a 28-year-old girl suffering from aortic coarctation syndrome (coarctation + ventricular septal defect + bicuspid aorta). She underwent coarctectomy with subclavian flap and pulmonary bandage followed by ventricular septal defect closure and bandage removal in her first year of life. When she was 27 years old, a follow-up echocardiography detected an isthmic pressure gradient and a demodulated Doppler in abdominal aorta. A cardiac catheterisation confirmed the diagnosis of aortic re-coarctation. An AndraStent® XL 48 mm was implanted with a resolution of the isthmic gradient. One year later, because of the reappearance of demodulated Doppler in abdominal aorta, a chest X-ray was performed, which showed a stent third-grade fracture. The fracture was corrected by positioning a covered stent cheatham platinum 45 mm through the fragments. The rarest complication after stenting procedures is the fracture of the device with an incidence between 0.01% and 0.08%. Pressure overload beyond the elastic threshold of the material and the pulsatile tension exerted by the blood flow on the walls of the stent are the main mechanisms at the base of the fracture, together with the compliance of the tissue. A vessel that underwent multiple surgical rearrangements could interfere with and complicate the physiopathology at the basis of the fracture. In conclusion, stenting is a safe technique to treat aortic coarctation; stent fracture is a rare event, and different anatomical and haemodynamic factors are related to this complication.
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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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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10
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Experience of stent implantation for recurrent aortic arch obstruction following Norwood or Damus-Kaye-Stansel operation over the last decade. Cardiol Young 2019; 29:1137-1142. [PMID: 31337447 DOI: 10.1017/s1047951119001549] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate. METHODS We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus-Kaye-Stansel procedure over the past decade at a single national cardiology centre. RESULTS Of 114 children who underwent Norwood procedure or Damus-Kaye-Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2-82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10-70mmHg) to 2mmHg (range 0-20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2-7.9 mm) to 8.6 mm (range 6.2-10.9 mm). The median coarctation index increased by 0.49 (range = 0.24-0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications. CONCLUSIONS The prevalence of recurrent aortic arch obstruction following Norwood/Damus-Kaye-Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.
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Meijs TA, Warmerdam EG, Slieker MG, Krings GJ, Molenschot MMC, Meijboom FJ, Sieswerda GT, Doevendans PA, Bouma BJ, de Winter RJ, Mulder BJM, Voskuil M. Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis. Heart 2019; 105:1464-1470. [PMID: 31315937 DOI: 10.1136/heartjnl-2019-314965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Long-term prognosis of patients with coarctation of the aorta (CoA) is impaired due to the high prevalence of hypertension and consequent cardiovascular complications. Although stent implantation results in acute anatomical and haemodynamic benefit, limited evidence exists regarding the late clinical outcome. In this meta-analysis, we aimed to evaluate the medium-term effect of stent placement for CoA on systemic blood pressure (BP). METHODS PubMed, EMBASE and Cochrane databases were searched for non-randomised cohort studies addressing systemic BP ≥12 months following CoA stenting. Meta-analysis was performed on the change in BP from baseline to last follow-up using a random-effects model. Subgroup analyses and meta-regression were conducted to identify sources of heterogeneity between studies. RESULTS Twenty-six studies with a total of 1157 patients and a median follow-up of 26 months were included for final analysis. Meta-analysis showed a 20.3 mm Hg (95% CI 16.4 to 24.1 mm Hg; p<0.00001) reduction in systolic BP and an 8.2 mm Hg (12 studies; 95% CI 5.2 to 11.3 mm Hg; p<0.00001) reduction in diastolic BP. A concomitant decrease in the use of antihypertensive medication was observed. High systolic BP and peak systolic gradient at baseline and stenting of native CoA were associated with a greater reduction in systolic BP at follow-up. CONCLUSIONS Stent implantation for CoA is associated with a significant decline in systolic and diastolic BP during medium-term follow-up. The degree of BP reduction appears to be dependent on baseline systolic BP, baseline peak systolic gradient, and whether stenting is performed for native or recurrent CoA.
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Affiliation(s)
- Timion A Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mirella M C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gertjan T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Complications After Stent Placement for Aortic Coarctation: A Pictorial Essay of Computed Tomographic Angiography. J Thorac Imaging 2018; 32:W69-W80. [PMID: 29065009 DOI: 10.1097/rti.0000000000000303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Stent placement is commonly used to treat aortic coarctation. Although invasive angiography remains the gold standard, follow-up is often performed using computed tomography, which allows rapid, noninvasive assessment of the aorta and surrounding tissues. The goal of this pictorial essay is to provide a guide to the interpretation of these examinations. Normal and abnormal computed tomographic appearance of different stent types is shown along with reconstructions that can help assess stent integrity and the stent position in relation to the aortic wall and branches. Furthermore, imaging findings of complications including aortic wall injuries, restenosis, and intimal hyperplasia are depicted.
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13
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Kang SL, Tometzki A, Taliotis D, Martin R. Stent Therapy for Aortic Coarctation in Children <30 kg: Use of the Low Profile Valeo Stent. Pediatr Cardiol 2017; 38:1441-1449. [PMID: 28780709 DOI: 10.1007/s00246-017-1682-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
Abstract
To report our experience of coarctation stent therapy in small children weighing less than 30 kg, with the low profile dilatable Valeo stent and review the literature on coarctation stent therapy in this patient population. Coarctation stent implantation was undertaken in 14 consecutive children using the Bard Valeo Stent. Demographic, angiographic, echocardiographic and clinical data were reviewed retrospectively. The median age at the time of procedure was 5.1 (2.6-7.5) years and median weight was 20.8 (14.7-27) kg. There was improvement in median coarctation diameter from 4 (1.3-5.2) to 9.5 (5.8-12.7) mm, p < 0.001; and a reduction in the median peak pressure gradient across the coarctation from 35 (20-49) to 9 (0-15) mmHg, p < 0.001. Median stent recoil was 7.9 (0-20)%. There was one case of access related complication that resolved without sequelae. Follow-up was a median of 15 (3.0-57.2) months. CT angiogram performed at a median time of 3.3 (2.6-10.2) months post procedure showed no aortic wall injury and preserved stent integrity in all cases. Two children underwent re-intervention for stent dilation and further stent implantation due to in-stent stenosis and somatic growth after 3 years. Six of fourteen children remained on a single antihypertensive agent post-intervention at last follow-up. Implantation of the dilatable Valeo stent is a feasible treatment strategy in native or recurrent coarctation in small children, accepting that additional stent implantation may be necessary with somatic growth. Further study is required to determine longer-term stent efficacy and clinical outcome.
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Affiliation(s)
- Sok-Leng Kang
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Andrew Tometzki
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Demetris Taliotis
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Robin Martin
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
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14
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Salcher M, Mcguire A, Muthurangu V, Kelm M, Kuehne T, Naci H. Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model. BMC Health Serv Res 2017; 17:258. [PMID: 28395657 PMCID: PMC5387244 DOI: 10.1186/s12913-017-2215-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Undesirable outcomes in health care are associated with patient harm and substantial excess costs. Coarctation of the aorta (CoA), one of the most common congenital heart diseases, can be repaired with stenting but requires monitoring and subsequent interventions to detect and treat disease recurrence and aortic wall injuries. Avoidable costs associated with stenting in patients with CoA are unknown. METHODS We developed an economic model to calculate potentially avoidable costs in stenting treatment of CoA in the United Kingdom over 5 years. We calculated baseline costs for the intervention and potentially avoidable complications and follow-up interventions and compared these to the costs in hypothetical scenarios with improved treatment effectiveness and complication rates. RESULTS Baseline costs were £16 688 ($25 182) per patient. Avoidable costs ranged from £137 ($207) per patient in a scenario assuming a 10% reduction in aortic wall injuries and reinterventions at follow-up, to £1627 ($2455) in a Best-case scenario with 100% treatment success and no complications. Overall costs in the Best-case scenario were 90.2% of overall costs at Baseline. Reintervention rate at follow-up was identified as most influential lever for overall costs. Probabilistic sensitivity analysis showed a considerable degree of uncertainty for avoidable costs with widely overlapping 95% confidence intervals. CONCLUSIONS Significant improvements in the treatment effectiveness and reductions in complication rates are required to realize discernible cost savings. Up to 10% of total baseline costs could be avoided in the best-case scenario. This highlights the need to pursue patient-specific treatment approaches which promise optimal outcomes.
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Affiliation(s)
- Maximilian Salcher
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Alistair Mcguire
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, Great Ormond Street Hospital, London, UK
| | - Marcus Kelm
- Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Huseyin Naci
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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15
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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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16
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Gadolinium-free MR in coarctation—can contrast-enhanced MR angiography be replaced? Clin Imaging 2016; 40:414-8. [DOI: 10.1016/j.clinimag.2015.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/23/2015] [Accepted: 12/02/2015] [Indexed: 11/21/2022]
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17
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Chen CK, Cifra B, Morgan GJ, Sarkola T, Slorach C, Wei H, Bradley TJ, Manlhiot C, McCrindle BW, Redington AN, Benson LN, Mertens L. Left Ventricular Myocardial and Hemodynamic Response to Exercise in Young Patients after Endovascular Stenting for Aortic Coarctation. J Am Soc Echocardiogr 2016; 29:237-46. [DOI: 10.1016/j.echo.2015.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Indexed: 10/22/2022]
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18
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Fujii T, Tomita H, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T. Current trends in stenting for aortic coarctation in Japan: Subanalysis of Japanese Society of Pediatric Interventional Cardiology (JPIC) stent survey. Pediatr Int 2016. [PMID: 26212515 DOI: 10.1111/ped.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stenting for aortic coarctation (CoA) has been accepted as an alternative to surgery for adolescents and adults, but only a few case have been reported in Japan. The purpose of this study was to provide a detailed review of Japanese national data on stenting of CoA. METHODS In a subanalysis of the data of the Japanese Society of Pediatric Interventional Cardiology (JPIC), we identified 35 patients with CoA who underwent stenting. We analyzed procedural characteristics including factors that may have contributed to hemodynamic effectiveness, and we compared these parameters between the patients under and over 15 years of age. RESULTS The mean ratio of balloon diameter/minimum lumen diameter (MLD) before stenting was 1.7 (range, 1.2-4.0), and the mean difference between the balloon diameter and the reference vessel diameter was -0.7 mm (range, -5.0 to +3.0 mm). %MLD/balloon diameter, which was defined as [(balloon diameter - MLD after dilation)/balloon diameter] × 100 predicted achievement of <10 mmHg pressure gradient after stenting. The sensitivity and the specificity of its cut-off of 7% were 93% and 47% (AUC, 0.7), respectively. There was no statistical difference between the two age groups under and over 15 years of age, in terms of selection criteria of stent size, balloon type used for deployment and immediate angiographic and hemodynamic result. CONCLUSIONS Stenting for CoA was clinically effective with few complications in Japan, even in patients not fully grown.
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Affiliation(s)
- Takanari Fujii
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideshi Tomita
- Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shinichi Otsuki
- Division of Pediatric Cardiology, Department of Pediatrics, Okayama University, Okayama, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasuo Ono
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Satoshi Yazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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19
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Circumferential stent fracture repaired using a covered stent in a 42-year-old man with coarctation of the aorta. Cardiol Young 2016; 26:375-7. [PMID: 26100260 DOI: 10.1017/s1047951115001079] [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] [Indexed: 11/07/2022]
Abstract
We present a case of circumferential fracture of aortic coarctation stent with severe re-stentosis presenting 16 years after initial stent implantation with end-stage renal disease. The patient was treated with a covered stent using the stent-in-stent technique. The use of an ultra-high-pressure balloon was proved necessary to overcome the tight, non-compliant stenosis.
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20
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Early and Long-Term Results of Stent Implantation for Aortic Coarctation in Pediatric Patients Compared to Adolescents: A Single Center Experience. Cardiol Res Pract 2016; 2016:4818307. [PMID: 26925287 PMCID: PMC4748096 DOI: 10.1155/2016/4818307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/08/2016] [Accepted: 01/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Stents have become the treatment of choice for native aortic coarctation in adults and adolescents, but in pediatric patients insufficient data are currently available to identify the best therapeutic option. Methods. To compare the outcomes of pediatric and adolescent patients, we retrospectively evaluated early and long-term results of stenting for aortic coarctation in 34 patients divided into 2 groups (A and B) composed, respectively, of 17 children (mean age 8.2 ± 2.3, weight ≤30 kg) and 17 adolescents (mean age 14.3 ± 1.7, weight >30 kg). Results. No significant differences in outcome were found between groups immediately after the procedure. In all of our patients, peak systolic gradient pressure significantly decreased after stenting from 43.7 ± 12 to 1.7 ± 3.1 mmHg in group A and from 39.4 ± 16.8 to 1.6 ± 3 in group B (p < 0.0001). We observed early and late adverse events in both groups: early femoral vessel injury or thrombosis was more frequent in younger patients, as well as restenosis due to vessel growth requiring stent redilatations, often complicated by stent fractures. Data from long-term follow-up showed that, in younger patients, stress-related hypertension was more frequent. Conclusions. The procedure was immediately safe and effective in both groups. Pediatric patients must be accurately selected before stenting because they could probably need reinterventions and stents could impact on their future therapeutic perspectives.
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21
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Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults. Arch Cardiovasc Dis 2015; 108:626-33. [PMID: 26522073 DOI: 10.1016/j.acvd.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/17/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults. METHODS Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months. RESULTS There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P<0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 ± 18 mmHg vs. 137 ± 17 mmHg vs. 142 ± 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 ± 14 mmHg vs. 132 ± 16 mmHg vs. 131 ± 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG >25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96). CONCLUSION Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups.
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22
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Saxena A. Recurrent coarctation: interventional techniques and results. World J Pediatr Congenit Heart Surg 2015; 6:257-65. [PMID: 25870345 DOI: 10.1177/2150135114566099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Coarctation of the aorta (CoA) accounts for 5% to 8% of all congenital heart defects. With all forms of interventions for native CoA, repeat intervention may be required due to restenosis and/or aneurysm formation. Restenosis rates vary from 5% to 24% and are higher in infants and children and in those with arch hypoplasia. Although repeat surgery can be done for recurrent CoA, guidelines from a number of professional societies have recommended balloon angioplasty with or without stenting as the preferred intervention for patients with isolated recoarctation. For infants and young children with recurrent coarctation, balloon angioplasty has been shown to be safe and effective with low incidence of complications. However, the rates of restenosis and reinterventions are high with balloon angioplasty alone. Endovascular stent placement is indicated, either electively in adults or as a bailout procedure in those who develop a complication such as dissection or intimal tear after balloon angioplasty. Conventionally bare metal stents are used; these can be dilated later if required. Covered stents, introduced more recently, are best reserved for those who have aneurysm at the site of previous repair or who develop a complication such as aortic wall perforation or tear. Stents produce complete abolition of gradients across the coarct segment in a majority of cases with good opening of the lumen on angiography. The long-term results are better than that of balloon angioplasty alone, with very low rates of restenosis. However, endovascular stenting is a technically demanding procedure and can be associated with serious complications rarely.
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Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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23
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Abstract
OBJECTIVE. The purpose of this article is to summarize the roles of CT and MRI in the diagnosis and follow-up of patients with aortic coarctation. CONCLUSION. Aortic coarctation is a common congenital heart disease accounting for approximately 6-8% of congenital heart defects. Despite its deceptively simple anatomic presentation, it is a complex medical problem with several associated anatomic and physiologic abnormalities. CT and MRI may provide very accurate information of the coarctation anatomy and other associated cardiac abnormalities.
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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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25
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Ostovan MA, Kojuri J, Mokhtaryan M, Razazi V, Zolghadrasli A. Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A Single Center Study. J Cardiovasc Thorac Res 2014; 6:117-21. [PMID: 25031828 PMCID: PMC4097852 DOI: 10.5681/jcvtr.2014.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/02/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Coarctation of aorta is the fourth most common cardiac lesion requiring intervention. While surgery used to be the only treatment option, endovascular intervention is now considered the first option in simple coarctation lesions. Despite increased popularity, there are currently no FDA approved stents for use in coarctation of aorta and data on the outcome of this procedure is still sparse. METHODS Between October 2004 and June 2010, 33 patients who underwent treatment with Cheatham-Platinum stents for coarctation of aorta were retrospectively studied. All the patients underwent control CT scans at 6 month and echocardiography at 1 year follow-up. RESULTS There were 17 females and 16 males with a mean age of 26.64 ± 16.30 years (range 2-71 years). The mean stent length and balloon diameter were 3.18 ± 0.56 mm and 15.7 ± 3.12 mm respectively. We achieved an immediate success rate of 96.9% with the only complication of aortic rupture which led to our single mortality in this series. At 6 month follow up no complications were noted in the CT scans. The mean echocardiographic aortic arch gradient at one year follow up was 21.73 ± 11.06 mmHg. CONCLUSION This study is one of the few cohorts of patients with stenting for coarctation of aorta in Iranian population which comprised a diverse group of patients from early childhood to elderly. It was demonstrated in this study that stenting for coarctation of aorta is a safe and effective procedure if done carefully and performed in selected patients.
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Affiliation(s)
- Mohammad Ali Ostovan
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Mokhtaryan
- Students' Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vida Razazi
- School of Management and Information, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolali Zolghadrasli
- Shiraz Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Luijendijk P, Bouma BJ, Groenink M, Boekholdt M, Hazekamp MG, Blom NA, Koolbergen DR, de Winter RJ, Mulder BJM. Surgical versus percutaneous treatment of aortic coarctation: new standards in an era of transcatheter repair. Expert Rev Cardiovasc Ther 2014; 10:1517-31. [DOI: 10.1586/erc.12.158] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Shepherd E, Connolly GM, Morgan G. Using the Valeo dilatable stent in coarctation stenting for small children: expanding the inclusion criteria for coarctation stenting? BMJ Case Rep 2013; 2013:bcr-2013-202095. [PMID: 24336586 DOI: 10.1136/bcr-2013-202095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The application of coarctation stenting has grown in paediatric and adult practice in recent years. Stent and delivery sheath technology has improved; however, we remain technically limited when implanting small calibre stents through small sheaths in small children, which then have the potential to be dilated to adult size as time passes. We describe the first reported use of the Valeo Biliary Pre-mounted Re-dilatable Stent (Edwards Life Sciences, California, USA) in aortic coarctation with 1 year follow-up including cross-sectional imaging. This 14 kg 3-year-old girl presented following an intracerebral haemorrhage secondary to severe systemic hypertension. Despite implantation through a 7-French sheath, this stent can be postdilated up to 20 mm, and therefore provides an important new addition to the interventional armamentarium.
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Affiliation(s)
- Emma Shepherd
- Department of Medicine, University of Bristol, Bristol, UK
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McElhinney DB, Marshall AC, Schievano S. Fracture of Cardiovascular Stents in Patients With Congenital Heart Disease. Circ Cardiovasc Interv 2013; 6:575-85. [DOI: 10.1161/circinterventions.113.000148] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Doff B. McElhinney
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
| | - Audrey C. Marshall
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
| | - Silvia Schievano
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
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Ferrara SL, Kinney TB, Hall LD. Endovascular treatment of a congenital thoracic aortic aneurysm in a premature newborn. J Vasc Interv Radiol 2012; 23:1330-4. [PMID: 22999752 DOI: 10.1016/j.jvir.2012.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 35(2)/(7) weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis.
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MESH Headings
- Aortic Aneurysm, Thoracic/congenital
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/therapy
- Aortography/methods
- Cesarean Section
- Embolization, Therapeutic
- Endovascular Procedures/instrumentation
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Magnetic Resonance Imaging
- Male
- Pregnancy
- Radiography, Interventional
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal/methods
- Young Adult
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Affiliation(s)
- Stephen L Ferrara
- Department of Radiology, Naval Medical Center, San Diego, California, USA.
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31
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Akagi T. Catheter intervention for adult patients with congenital heart disease. J Cardiol 2012; 60:151-9. [DOI: 10.1016/j.jjcc.2012.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/07/2012] [Indexed: 02/02/2023]
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Bozzani A, Odero A. Stent implantation in the native and recurrent aortic coarctation in children. Am J Cardiol 2012; 109:1822; author reply 1822-3. [PMID: 22658066 DOI: 10.1016/j.amjcard.2012.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 03/16/2012] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
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