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- Title
Percutaneous Management of Coarctation of the Aorta in Adult Patients: A Single-Centre Experience.
- Authors
Sürücü, Murat; Çelebi, Ahmet
- Abstract
Objective Native aortic coarctation (NaCoA) is a relatively common congenital heart defect. Recoarctation of the aorta (ReCoA) refers to recurrent obstruction after an initially successful percutaneous dilatation or surgical repair, with reported rates ranging from 5% to 50%. Percutaneous management with stent implantation is a widely accepted treatment modality for both NaCoA and ReCoA in adult patients. The aim of this study was to describe results of percutaneous management of both NaCoA and ReCoA in adult patients. METHODS Data of all patients who underwent percutaneous stent implantation of aortic coarctation between January 2012 and June 2023 were analyzed and 80 adult patients were included in the study. Coarctation of the aorta was defined as a systolic upper-to lower limb blood pressure gradient =20 mmHg and/or significant obstruction on echocardiography or other imaging techniques (CT, MRI, conventional angiography). Balloon expandable stent (covered or bare) implantation was performed all patients. Balloon diameter was typically based on the size of the descending aorta at the level of the diaphragm. Stent length was selected so as to completely cover the stenotic area. Successful dilatation was defined as a residual PPG < 20 mmHg. Demographic characteristics, echocardiography, angiocardiography findings, early and mid-term follow-up results, need for re-intervention, and complications were evaluated. The patients were evaluated before discharge and 1 month, 3 months, and 6 months after the procedure and at 6-month intervals thereafter. RESULTS Eighty adult patients (51 males, 29 females) underwent percutaneous stent implantation of CoA in the Pediatric Cardiology department of our hospital between 2012 and 2023. There were 66 patients with NaCoA and 14 patients with ReCoA (after surgery in 8, previous balloon angioplasty in 6 patients). The median age and weight were 25 (18-54) years and 68 (43-100) kg, respectively. The median diameter at the narrowest part of the coarctation was 6 mm, the median peak-to-peak pressure was 44 (range 15-113) mmHg before the procedure and 1 (range 0-18) mmHg after the procedure. The mean diameter of the balloons used for stent implantation was 16.1 ± 3.2 (range 10-26 mm), the median stent length was 43 mm (range 16-57 mm). Bare stent was used in 42 patients and covered stent was used in 38 patients. The majority of patients (n=54) were treated with Cheatham-Platinum (CP) stent. Other stents utilized included AndraStent® XL/XXL stent (n=22), Optimus XL/XXL stent (n=4). In three patients with interrupted aortic arch, an angiography was performed simultaneously using the right radial artery and femoral artery, revealing an atretic segment. Subsequently, the atretic segment was crossed using a CTO wire, and after a staged balloon angioplasty, stent implantation was applied via the femoral artery. In six patients with subatretic coarctation, pre-stent implantation, small size non-compliant balloons were used for balloon angioplasty to facilitate the retrograde passage of a long sheath. In the early postoperative period, major complications were seen in four patients, including cerebrovascular infarction in three patients and iliac artery dissection in one patient. The patient with iliac artery dissection died due to acute intra-abdominal bleeding. The median follow-up duration was 28 (range 1 - 108 months). It was observed that hypertension persisted in 46 patients, improved in 20 patients (not require medication). Data of 13 patients could not be accessed because they did not continue to be followed up. CONCLUSIONS Stent implantation for native and re -coarctation is performed safely in adults, with a high degree of immediate procedural success.
- Subjects
AORTIC coarctation; ECHOCARDIOGRAPHY; CARDIAC catheterization; SURGICAL stents; MEDICAL centers
- Publication
E Journal of Cardiovascular Medicine, 2023, Vol 11, p1
- ISSN
2147-1924
- Publication type
Article