Sequential dilation strategy in stent therapy of the aortic coarctation: A single centre experience
Introduction
Coarctation of the aorta (CoA) is defined as a significant narrowing of the aortic isthmus, at the insertion of the arterial band [1]. It accounts for 5%–8% of all congenital heart defects and is considered as a part of a generalized arteriopathy, associated with valvulopathy, vasculopathy and cerebrovascular disease [[1], [2], [3], [4]].
Surgery and catheter interventional techniques are available alternatives for management of CoA. Even if the surgical results are excellent and repair can be performed with freedom from major complications in most of the patients [5], survival remains limited due to comorbidities such as arterial hypertension and re-interventions/re-operations needed in long term follow-up [6,7]. One of the most frequent reasons leading to a re-intervention or re-operation is the recurrent coarctation of the aorta (Re-CoA) after its surgical or interventional treatment.
Over the last 20 years, stent implantation has become the treatment of choice for native CoA and Re-CoA in older children, adolescents and adults in many cardiac centres. A perceived higher risk associated with open surgery in particular with repeated surgery for CoA, and a convenience argument -lack of thoracotomy scar, reduction of physical impairment, shorter hospital stay- for the patient has facilitated this shift [8,9]. In this study, we report the midterm results in children, adolescents, and adult patients who underwent endovascular stent placement for both native CoA and Re-CoA regarding complications, re-interventions and arterial hypertension as a most important concomitant phenomenon of aortic coarctation.
Section snippets
Study subjects
We retrospectively analysed the data of all consecutive patients, who underwent cardiac catheterisation for native and recurrent aortic coarctation at German Heart Centre Munich between February 1999 and October 2017.
The goal of the study was to evaluate the rate of reinterventions, procedure-related complications and the course of blood pressure following aortic coarctation stenting at a median follow-up time of 31 months (range 0–216 months).
Only patients above 6 years old were included in
Patients
There were 218 patients treated with an interventional stent implantation. A total of 101 patients (46.3%) were diagnosed with native CoA and 117 patients (53.7%) developed Re-CoA after surgical correction (84 patients with end to end anastomosis,13 patients with graft interposition, 16 patients with aortic arch reconstruction, 4 patients with subclavian flap). From Re-CoA patients, 22 patients had more than one surgical operation for recurrent CoA. The detailed patient characteristics are
Discussion
This study shows, that CoA stenting is an effective means for treatment of native – and recurrent coarctation (Re-CoA). With sequential dilation of the CoA-Stent, a very low rate of life-threatening procedural complications and mortality can be achieved. CoA stenting with proper antihypertensive medications results in better control of blood pressure.
In many cases, a Re-CoA can be successfully treated with a balloon angioplasty and an open surgery can be avoided. However, with a balloon
Conclusion
The intermediate outcome of our study with 218 patients and a median follow-up time of 31 months, is encouraging for endovascular stent implantation as a treatment of choice in patients with native and recurrent aortic coarctation. The mortality is low and with sequential dilation of the CoA-stent, major complications can be avoided. Furthermore, CoA stenting with proper antihypertensive medications results in better control of blood pressure. However, patients with a CoA, those with surgical
Funding statement
MF is funded through a research grant from the Egyptian Ministry of High Education (PhD Scholarship).
Author statement
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Conception and design of the study: PBH, MF, AH, SC, SG, DT, PE, JH, AE
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Acquisition of the data: PBH, MF, SC, SG, DT, PE, AE
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Analysis and/or interpretation of the data: PBH, MF, AH, SC, AE
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Drafting the manuscript: PBH, MF, AE
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Revising the manuscript critically for important intellectual content: PBH, MF, AH, SC, SG, DT, PE, JH, AE
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Approval of the version of the manuscript to be published: PBH, MF, AH, SC, SG, DT, PE, JH, AE
Declaration of Competing Interest
None declared.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.