1
|
Anderson B, Justo R, Ward C. Early Experience With the Bentley BeGraft Aortic Stent for the Management of Aortic Arch Pathology in the Paediatric Population. Heart Lung Circ 2023:S1443-9506(23)00145-2. [PMID: 37072280 DOI: 10.1016/j.hlc.2023.03.008] [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: 06/30/2022] [Revised: 01/08/2023] [Accepted: 03/14/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Aortic arch pathology in older children is often treated preferentially with stenting. Both bare metal and covered stents have been utilised, with potential advantages of covered stents. The search for the ideal covered stent continues. METHODS Retrospective review of all paediatric patients undergoing treatment of aortic arch pathology utilising the Bentley BeGraft Aortic stent (BeGraft Aortic, Bentley InnoMed, Hechingen, Germany) from June 2017 to May 2021. Outcome measures were procedural success, complications, medium-term patency and need for re-intervention. RESULTS Fourteen (14) stents were placed in 12 children (seven males). Indications were coarctation of the aorta in 10 and aneurysm in two. Median age was 11.8 years (8.7-16.6 years) and median weight 42.5 kg (24.8-84 kg). Median coarctation narrowing of 4 mm (range 1-9 mm), improved to 11 mm (range 9-15 mm). The median coarctation gradient improved from 32 mmHg (range 11-42 mmHg) to 7 mmHg (range 0-14 mmHg). Both aneurysms were successfully occluded. There was no mortality or major morbidity. In one patient balloon rupture occurred requiring a second balloon for full inflation and one patient had a minor access site bleed. Follow-up median was 28 months (range 13-65 months). One patient underwent repeat balloon dilation for increased blood pressure gradient at 47 months post implant and a second patient additional stent insertion for a mid-stent aneurysm at 65 months. CONCLUSION The Bentley BeGraft Aortic stent can be safely deployed in children for the treatment of aortic arch pathology. Medium-term patency is acceptable. Longer term follow-up in larger series will be required to assess stent performance.
Collapse
Affiliation(s)
- Benjamin Anderson
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia.
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia
| | - Cameron Ward
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia
| |
Collapse
|
2
|
Hanazuka T, Sakata T, Ueda H, Watanabe M, Matsumiya G. Late open conversion after endovascular treatment for the coarctation of aorta in adult due to restenosis with thrombus. J Vasc Surg Cases Innov Tech 2022; 8:338-344. [PMID: 35812122 PMCID: PMC9263744 DOI: 10.1016/j.jvscit.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
A 22-year-old man was referred to our hospital for rib notching found on a radiograph and hypertension. Computed tomography revealed coarctation of the descending aortic isthmus. Because he refused open surgery, endovascular treatment was performed. The 2-year follow-up computed tomography scan showed infolding of the stent graft and thrombus formation. He had presented with intermittent claudication; therefore, graft interposition was performed. Endovascular surgery plays an important role in the treatment of coarctation of the aorta. However, insufficient dilatation can lead to restenosis accompanied by thrombus formation, and excess ballooning can cause aortic wall injury. Careful performance of the procedure and close postoperative follow-up are essential.
Collapse
|
3
|
Simultaneous interventional therapy for coarctation of the aorta combined with intracristal ventricular septal defect in older age adult. J Geriatr Cardiol 2022; 19:481-484. [PMID: 35845156 PMCID: PMC9248280 DOI: 10.11909/j.issn.1671-5411.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
4
|
Peng Z, Qiu J, Wang D, Yang X, Yu C, Zhang L. Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions. Vasc Endovascular Surg 2021; 56:11-17. [PMID: 34488512 DOI: 10.1177/15385744211042194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the efficacy and safety of ascending aortoiliac bypass surgery for one-stage repair of adult coarctation of the aorta (CoA) and concomitant cardiac disease. METHODS From March 2012 to October 2018, 51 consecutive CoA patients were treated with ascending aorta to bilateral iliac artery bypass concomitant with and cardiac surgerical procedures performed for a variety of reasons. A Y-shaped graft was used for the bypass procedure. We evaluated early outcomes, including postoperative death, systolic blood pressure and differences between upper and lower limb blood pressure. RESULTS The average age was 41 years and 64.7% of patients were men. Simultaneous cardiac procedures included aortic valve replacement, ventricular septal defect repair, Bentall procedures and Wheat procedures. No deaths occurred in the early postoperative period. Three patients had delayed healing at the site of the abdominal lower quadrant incisions. The average systolic pressure in the upper limb and the average difference between the upper- and lower-limb blood pressure decreased significantly after surgery (162.7 ± 13.4 mmHg vs 128.4 ± 6.7 mmHg, P = .000; 69.6 ± 15.6 mmHg vs 8.7 ± 7.6 mmHg, P = .000, respectively); The systolic blood pressure in the lower limb increased after bypass surgery (93.1 ± 6.2 mmHg vs 119.6 ± 7.7 mmHg, P = .000). The follow-up rate was 100%, with an average follow-up time of 61 months. Six patients (11.8%) had graft stenosis or occlusion. Three patients (5.9%) underwent endovascular embolectomy. CONCLUSIONS In our small series, ascending aortoiliac bypass for one-stage repair of CoA with concomitant cardiac lesions appears safe and efficacious in effectively reduceing differences between upper and lower limb systolic blood pressure. Further study with larger sample size and longer follow-up is needed.
Collapse
Affiliation(s)
- Zhan Peng
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
| | - Juntao Qiu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - De Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiubin Yang
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
| | - Cuntao Yu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liang Zhang
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
[Therapeutic endovascular procedures in aortitis]. Rev Med Interne 2016; 37:279-83. [PMID: 26869293 DOI: 10.1016/j.revmed.2015.12.031] [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: 12/24/2015] [Accepted: 12/31/2015] [Indexed: 11/22/2022]
Abstract
Aortitis is an inflammation of the aortic wall with an infectious or non-infectious origin, which often progresses to vascular complications. The open surgical approach is a high-risk procedure for these pathologies. Endovascular interventions have improved the prognosis of patients with aortitis complications. This manuscript describes the pathophysiology responsible for vascular complications and the role of endovascular approach for their treatment.
Collapse
|
7
|
Abstract
Diffuse aortitis, as seen in Takayasu disease, is characterised by extreme wall fragility, associated with a high risk of complications such as dissection and aneurysm formation, following endovascular treatment. We report a patient with Takayasu disease who presented with a very difficult clinical course associated with several unfavourable outcomes of stent insertion.
Collapse
|
8
|
Li Y, Fan Z, Huang L, Xue Y, Sun L. A novel approach for hybrid repair of type B aortic dissection associated with coarctation of the aorta. J Vasc Surg 2013; 59:1422-5. [PMID: 24342070 DOI: 10.1016/j.jvs.2013.05.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/05/2013] [Accepted: 05/13/2013] [Indexed: 10/25/2022]
Abstract
We report the case of an acute type B aortic dissection in association with an unknown isthmic coarctation in a 53-year-old man. An intimal tear was located just distal to the coarctation, and the intimal flap extended to the level of the renal arteries. Hybrid repair was performed successfully 4 months later, without deep hypothermic circulatory arrest. An extra-anatomic bypass connected the ascending aorta to the abdominal aorta. The coarctation was occluded using a ventricular septal defect occluder. The hybrid repair was safe and effective for the patient.
Collapse
Affiliation(s)
- Yu Li
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
| | - Yuguo Xue
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
Hayes N, Podnar T, Qureshi S. Collapse of the advanta V12 large diameter covered stent following implantation for aortic coarctation. Catheter Cardiovasc Interv 2013; 83:109-14. [DOI: 10.1002/ccd.25139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/14/2013] [Accepted: 07/21/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Nicholas Hayes
- Evelina Children's Hospital; Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London E1 7EH United Kingdom
| | - Tomaž Podnar
- Department of Paediatrics; University Medical Center Ljubljana; Bohoričeva 20, 1000 Ljubljana Slovenia
| | - Shakeel Qureshi
- Evelina Children's Hospital; Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London E1 7EH United Kingdom
| |
Collapse
|
10
|
Sadiq M, Ur Rehman A, Qureshi AU, Qureshi SA. Covered stents in the management of native coarctation of the aorta--intermediate and long-term follow-up. Catheter Cardiovasc Interv 2013; 82:511-8. [PMID: 23592275 DOI: 10.1002/ccd.24945] [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] [Received: 12/16/2012] [Accepted: 04/07/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the results of covered Cheatham-Platinum stent implantation in the management of native coarctation of the aorta and report intermediate and long-term follow-up. BACKGROUND Covered stents are being used increasingly in severe and complex coarctation of the aorta mainly to reduce risk of aortic wall complications. There is, however, limited data on the intermediate and long-term outcome. PATIENTS AND METHODS Fifty-six patients received 59 covered Cheatham-Platinum stents (January 2002-December 2011) at a single center-in 54 patients as primary treatment and in 2 as a rescue. Mean age was 22.25 ± 1.2 (11-56) years and mean weight 58.6 ± 2.1 (32-99) kg. Primary end points were reduction in systolic pressure gradient and an increase in coarctation segment diameter. Changes in antihypertensive medicines and complications were recorded on follow-up. RESULTS Mean coarctation segment diameter increased from 4.69 ± 0.20 to 15.1 ± 3.2 mm (P < 0.0001). The systolic gradient decreased from mean of 51.4 ± 3.4 to 4.6 ± 0.7 mm Hg (P < 0.0001). There was one death 3 days postprocedure due to cerebral anoxia. There was one dissection diagnosed 24-hr postprocedure. At a mean follow-up of 45.9 ± 3.9 (3-120) months, all stents were patent and in good position on computed tomography. Four (7.1%) patients underwent successful redilation. Antihypertensive medication was decreased or stopped in 37 (66%) patients. CONCLUSIONS Covered Cheetham-Platinum stents may be used effectively as therapy of choice in selected patients with severe coarctation of the aorta. Aortic wall complications occur even with covered stents. Covered stents provide a safe alternative to conventional stenting in the intermediate and long-term and can be redilated safely to keep pace with somatic growth.
Collapse
Affiliation(s)
- Masood Sadiq
- Punjab Institute of Cardiology and The Children's Hospital/The Institute of Child Health, Lahore, Pakistan
| | | | | | | |
Collapse
|
11
|
Kook H, Rha SW, Kim W, Kim DH, Lee S, Oh SK, Ahn TH, Shim WH. A case of successful bare metal stenting for aortic coarctation in an adult. Korean Circ J 2013; 43:269-72. [PMID: 23682288 PMCID: PMC3654116 DOI: 10.4070/kcj.2013.43.4.269] [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: 06/14/2012] [Revised: 07/17/2012] [Accepted: 09/05/2012] [Indexed: 01/30/2023] Open
Abstract
Aortic coarctation is a correctable hypertensive disease. For safety reasons and due to the invasiveness of surgical techniques, percutaneous interventions have become drastically more popular in recent times. In elderly patients with aortic coarctation who are at risk of an aortic wall aneurysm and rupture, covered stents are preferred but in younger patients, bare metal stenting may be sufficient for long-term safety. Herein we present a 47-year-old typical aortic coarctation patient who was successfully treated with a bare metal stent.
Collapse
Affiliation(s)
- Hyungdon Kook
- Department of Internal Medicine, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Bruckheimer E, Pedra CAC. Stenting Options for Coarctation of the Aorta. Interv Cardiol Clin 2013; 2:115-129. [PMID: 28581978 DOI: 10.1016/j.iccl.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The narrowing of the lumen in coarctation of the aorta can be relieved with a high degree of immediate success by transcatheter methods. All methods are associated with immediate and longer-term complications, including dissection, aneurysm formation, and recoarctation. The introduction of the use of covered stents in aortic coarctation is encouraging because the material cover provides additional protection to the acutely disrupted aortic wall and can provide long-term protection of the dilated segment and the downstream area of poststenotic dilation. This review discusses the currently available options for stenting aortic coarctation.
Collapse
Affiliation(s)
- Elchanan Bruckheimer
- Pediatric Cardiac Catheterization, Schneider Children's Medical Center Israel, Kaplan 14, Petach Tikva, Israel.
| | - Carlos Augusto Cardoso Pedra
- Catheterization Laboratory for Congenital Heart Disease, Instituto Dante Pazzanese de Cardiologia, Avenida Doutor Dante Pazzanese, 500 CEP 04012-180, Sao Paulo, Brazil; Catheterization Laboratory for Congenital Heart Disease, Hospital do Coração, Sao Paulo, Brazil
| |
Collapse
|