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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Covered Cheatham-Platinum Stents for Aortic Coarctation

Early and Intermediate-Term Results

Aphrodite Tzifa, MRCPCH^_*, Peter Ewert, MD, Grazyna Brzezinska-Rajszys, MD, Bjoern Peters, MD, Maria Zubrzycka, MD, Eric Rosenthal, MRCP^_*, Felix Berger, MD and Shakeel A. Qureshi, FRCP^_*,_*

^_* Department of Congenital Heart Disease, Guy’s and St. Thomas’s Hospital, London, United Kingdom
Department of Congenital Heart Disease, German Heart Institute, Berlin, Germany
Department of Pediatric Cardiology, Children’s Memorial Hospital, Warsaw, Poland

Manuscript received June 12, 2005; revised manuscript received November 10, 2005, accepted November 15, 2005.

^_* Reprint requests and correspondence: Dr. Shakeel A. Qureshi, Department of Congenital Heart Disease, Evelina Children’s Hospital, St. Thomas’s Hospital, Lambeth Palace Road, London SE1 7EH, England (Email: shakeel.qureshi{at}gstt.nhs.uk).

OBJECTIVES: This study sought to evaluate the use of covered Cheatham-platinum (CP) stents in the treatment of aortic coarctation (CoA).

BACKGROUND: Aortic aneurysms and stent fractures have been encountered after surgical and transcatheter treatment for CoA. Covered stents have previously been used in the treatment of abdominal and thoracic aneurysms in adults. We implanted covered CP stents as a rescue treatment in patients with CoA aneurysms or previous stent-related complications and in patients at risk of developing complications because of complex CoA anatomy or advanced age.

METHODS: Thirty-three covered CP stents were implanted in 30 patients; 16 patients had had previous procedures. The remaining patients had complex or near-atretic CoA.

RESULTS: The mean patient age and weight were 28 (±17.5) years (range 8 to 65 years), and 62 (±13) kg (range 28 to 86 kg), respectively. The systolic gradient across the CoA decreased from a mean (±SD) of 36 ± 20 mm Hg before to a mean of 4 ± 4 mm Hg after the procedure (p < 0.0001), and the diameter of the CoA increased from 6.4 ± 3.8 mm to 17.1 ± 3.1 mm (p < 0.0001). The follow-up period was up to 40 months (mean, 11 months). All stents were patent and in good position on computed tomography or magnetic resonance imaging performed three to six months later. In 43% of the patients antihypertensive medication was either decreased or stopped.

CONCLUSIONS: Covered CP stents may be used as the therapy of choice in patients with complications after CoA repairs, whereas they provide a safe alternative to conventional stenting in patients with severe and complex CoA lesions or advanced age.

Abbreviations and Acronyms   CoA = aortic coarctation   CP = Cheatham-platinum

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