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Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg: A 12-Year Experience. | LitMetric

Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg: A 12-Year Experience.

Circ Cardiovasc Interv

Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.).

Published: February 2021

AI Article Synopsis

  • - The study investigates the effectiveness of adult-sized stent implantation (SI) in small patients (≤20 kg) with coarctation of the aorta (CoA), noting that SI is preferred over balloon angioplasty for better outcomes.
  • - A review of 39 patients showed significant improvements in artery function after SI, yet 69% required subsequent procedures, and 18% experienced procedural complications.
  • - The findings suggest that adult-sized SI can serve as a viable alternative to surgery for small patients with CoA, despite potential access-related issues that could be minimized with advancements in stent technology.

Article Abstract

Background: Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients.

Methods: A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed.

Results: Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3-7.9) years and 10 (5.5-20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18-42] to 0 mm Hg [IQR, 0-2]; < 0.05) and median minimum diameter (3.6 mm [IQR, 2.4-4.8] to 7.7 mm [IQR, 6.5-9.4]; <0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5-63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8-116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion.

Conclusions: Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.

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Source
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009399DOI Listing

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