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- Title
323-I PERCUTANEOUS TREATMENT OF ADULT POST-ISTHMIC AORTIC COARCTATION: ACUTE AND LONG-TERM OUTCOMES WITH A SELF-EXPANDABLE UNCOVERED NITINOL STENT.
- Authors
Kische, S.; D'Ancona, G.; Ortak, J.; Ince, H.
- Abstract
Objectives: To present perioperative and long-term results of percutaneous treatment of adult post-isthmic aortic coarctation by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL®, Optimed, Esslingen, Germany).Methods: Preoperative, perioperative, and long-term clinical and imaging data were prospectively collected and analysed.Results: A total of 52 consecutive patients were treated with the Sinus-XL® stent. Mean age was 36.6 years (21–67), peak invasive transcoarctation gradient was 54.7 ± 9.9 mmHg, and upper body hypertension unresponsive to medical treatment was present in all patients. Table 1 summarises perioperative results. Mean stent diameter and length were 24.2 mm (22–28 mm) and 70.4 mm (40–80 mm). Eight patients (15.4%) required coarctation predilatation. All patients underwent post-stent dilatation with a non-compliant balloon. Postoperative peak gradient (3.3 ± 2.5 mmHg) was significantly reduced (P < 0.001) and minimal aortic diameter was significantly increased (4.6 ± 1.9 mm vs 18.6 ± 2.5 mm; P < 0.001). All patients were discharged home (mean hospitalisation 3.5 days). At follow-up (47.6 months, 12–84) one (1.9%) non-cardiovascular mortality was reported. Aortic CT confirmed the absence of stent collapse, secondary migration and documented stability in coarctation diameter (18.3 ± 2.7 mm). Thirty patients (57.7%) were off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P < 0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P < 0.001).Mean procedural time (min)45.8 (35–92)Contrast agent amount (ml)80.1 (60–140)Stent migration1 (1.9%)Femoral artery dissection1 (1.9%)Self-contained aortic rupture1 (1.9%)Residual gradient >10 mmHg0Cerebrovascular accident0OR conversion0Conclusion: Adult aortic coarctation treatment with Sinus-XL® Optimed stent is safe and durable. The peculiar stent design maintains adequate localised radial strength over time, with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimisation is immediate and persistent even at long-term follow-up.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 19, Issue suppl_1, pS96
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu276.323