CONGENITAL HEART DISEASE
Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up
Mohamed A. Hamdan, MBBS*,
Sunita Maheshwari, MD*,
John T. Fahey, MD, FACC* and
William E. Hellenbrand, MD, FACC*,
* Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Babies and Children’s Hospital of New York, New York-Presbyterian Medical Center, New York, New York, USA
Manuscript received July 24, 2000;
revised manuscript received June 26, 2001,
accepted July 16, 2001.
* Reprint requests and correspondence: Dr. William E. Hellenbrand, Babies and Children’s Hospital of New York, New York-Presbyterian Medical Center, 3959 Broadway, 2 North, New York, New York 10032-3784 USA
wh148{at}columbia.edu
OBJECTIVES
The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA).
BACKGROUND
Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA).
METHODS
Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 ± 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation <20 mm Hg.
RESULTS
Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 ± 12 mm Hg to 4 ± 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 ± 0.16 to 0.92 ± 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 ± 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 ± 21 mm Hg before stent placement to 122 ± 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 ± 18 mm Hg to 4 ± 6 mm Hg, and peak Doppler gradient decreased from 51 ± 26 mm Hg to 13 ± 11 mm Hg at follow-up (p < 0.001).
CONCLUSIONS
Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.
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Abbreviations and Acronyms
| | BA | = balloon angioplasty | | CoA | = coarctation of the aorta | | DAo | = descending aorta | | ECMO | = extracorporeal membrane oxygenation | | HP | = high pressure | | LP | = low pressure | | MRI | = magnetic resonance imaging | | SBP | = systolic blood pressure | | TAR | = transverse aortic arch |
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