Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: A multi‐institutional study

Catheterization and Cardiovascular Interventions - Tập 70 Số 2 - Trang 276-285 - 2007
Thomas J. Forbes1,2,3, Swati Garekar1,2,3, Zahid Amin4, Evan M. Zahn5, David Nykanen5, Phillip Moore6, Shakeel A. Qureshi7, John P. Cheatham8, Makram R. Ebeid9,10, Ziyad M. Hijazi11, Satinder K. Sandhu11, Donald J. Hagler12, Horst Sievert13, Thomas E. Fagan14, Jeremy M. Ringewald15, Wei Du1,2,3, Liwen Tang1,2,3, David F. Wax16, John F. Rhodes17, Troy A. Johnston18, Thomas K. Jones18, Daniel R. Turner1,2,3, Carlos Augusto Cardoso Pedra19, William E. Hellenbrand20
1Children’s Hospital of Michigan
2Detroit, Michigan
3Wayne State University
4Children's Hospital of Omaha, University of Nebraska Creighton University, Omaha, Nebraska
5The Congenital Heart Institute at Miami Children's Hospital and Arnold Palmer Women and Children's Hospital, Miami, Florida
6University of California at San Francisco, San Francisco, California
7Guy's Hospital, London, England
8Columbus Children’s Hospital, Ohio State University, Columbus, Ohio
9Children's Hospital of Mississippi
10University of Mississippi, Jackson, Mississippi
11University of Chicago, Chicago, Illinois
12Mayo Clinic, Rochester, Minnesota
13Cardiovascular Center Bethanien, Frankfurt, Germany
14Children's Hospital of Iowa, University of Iowa, Iowa City, Iowa
15Medical University of South Carolina, Charleston, South Carolina
16Children's Memorial Hospital, Northwestern University, Lincoln Park, Illinois
17Duke Children's Heart Program, Duke University, Durham, North Carolina
18Seattle Children's Hospital, University of Washington, Seattle, Washington
19Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
20Babies and Children's Hospital of New York, Columbia Presbyterian, New York, New York

Tóm tắt

AbstractBackground: We report a multi‐institutional experience with intravascular stenting (IS) for treatment of coarctation of the aorta. Methods and Results: Data was collected retrospectively by review of medical records from 17 institutions. The data was broken down to prior to 2002 and after 2002 for further analysis. A total of 565 procedures were performed with a median age of 15 years (mean = 18.1 years). Successful reduction in the post stent gradient (<20 mm Hg) or increase in post stent coarctation to descending aorta (DAo) ratio of >0.8 was achieved in 97.9% of procedures. There was significant improvement (P < 0.01) in pre versus post stent coarctation dimensions (7.4 mm ± 3.0 mm vs. 14.3 ± 3.2mm), systolic gradient (31.6 mm Hg ± 16.0 mm Hg vs. 2.7 mm Hg ± 4.2 mm Hg) and ratio of the coarctation segment to the DAo (0.43 ± 0.17 vs. 0.85 ± 0.15). Acute complications were encountered in 81/565 (14.3%) procedures. There were two procedure related deaths. Aortic wall complications included: aneurysm formation (n = 6), intimal tears (n = 8), and dissections (n = 9). The risk of aortic dissection increased significantly in patients over the age of 40 years. Technical complications included stent migration (n = 28), and balloon rupture (n = 13). Peripheral vascular complications included cerebral vascular accidents (CVA) (n = 4), peripheral emboli (n = 1), and significant access arterial injury (n = 13). Older age was significantly associated with occurrence of CVAs. A significant decrease in the technical complication rate from 16.3% to 6.1% (P < 0.001) was observed in procedures performed after January 2002. Conclusions: Stent placement for coarctation of aorta is an effective treatment option, though it remains a technically challenging procedure. Technical and aortic complications have decreased over the past 3 years due to, in part, improvement in balloon and stent design. Improvement in our ability to assess aortic wall compliance is essential prior to placement of ISs in older patients with coarctation of the aorta. © 2007 Wiley‐Liss, Inc.

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Catheterization and Cardiovascular Interventions

Tập 70 Số 2

276-285

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