ORIGINAL ARTICLE
Immediate and intermediate results of stent
therapy for aortic coarctation
A.M. Honing-Hemmers, W.K van Putten, M. Gewillig, G. Mast, M. Talsma, R. Tanke, D. de Wolff, N. Sreeram
Objectives. The aim of the study was to assess the immediate and intermediate outcomes of stent therapy for coarctation or recoarctation of the aorta.
Setting. Terdary referral centres. Methods. A case review of all patients who have undergone stent implantation for coarctation of aorta in the Netherlands and Belgium. Results. Stents were implanted in 33 patients (mean age 21±16 years) and successfill outcome occurred acutely in 32 of these 33 patients. Peak systolic blood pressure decreased from 149±37 to 124±24 mmHg. The pressure gradient decreased from 37± 16 to 7±7 mmHg. The diameter of the coarctation segment increased from 7.3±3.8 to 13.3*3.9 mm. Three patients had major complications and three had minor complications. During a mean follow-up of 21*17 months recoarctation was found in ten patients, seven of whom have undergone fiurther procedures. There were no deaths at follow-up. A.M. HonlngHommers. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht. W.K. van Puten. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht.
0. Mast. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht. N. Sram. Department of Cardiology, Wilhelmina Children's Hospital,
Utrecht. M. Gow1114g
University Hospital Leuven, Belgium.
M. Talsma.
University Hospital Groningen. R. Tanks.
University Hospital N,jmegen. D. de Wolff.
University Hospital Gent, Belgium. Address for correspondence: N. Sreeram. E-mail: [email protected]
Nctherlands Heart Journal, Volume 11, Number 6, June 2003
Conclusions. Stent implantation is a good alternative to balloon dilation in selected patients with coarctation of the aorta. However, follow-up evaluation reveals a varying incidence of recoarctation and the long-term outcomes need to be determined. (Neth HeartJ 2003;1 1:245 -9.) Keywords: aortic coarctation, stent implantation S tent therapy has been advocated for coarctation of the aorta, both native and following previous balloon dilation or surgery (recoarctation). There are few large series describing the results of stent implantation for coarctation, and most of them are single-institution studies.'14 We report the immediate and intermediate results ofstent therapy for coarctation of the aorta from all paediatric cardiac centres in the Netherlands and Belgium where stent implantation has been undertaken. One infant aged 6 months, in whom stent implantation resulted in death, has been exduded from this study. That patient's case is currently the subject of a judicial enquiry, and it was felt to be inappropriate to comment further on the indications, results and outcomes ofthe procedure in order not to prejudice either the enquiry or the participants in that procedure. Methods Protocol The participating centres for the studywere Groningen, Nijmegen and Utrecht in the Netherlands, and Gent and Leuven in Belgium. Data regarding patients' clinical status were collected by chart review. Institutional review board approval was obtained for followup studies on all patients reported here. Patient confidentiality was maintained during data analysis and manuscript preparation. Coarctation of the aorta was defined as systolic arm-to-leg blood pressure gradient .20 mmHg and confirmed by echocardiographic (n=33), magnetic resonance (n=18) and/or angiographic imaging (and
245
Immediate and intermediate results of stent therapy for aortic coarctation
Tabe 1. Characteristics of the patients (n=33). Male/female Age (years) Hypertension Isolated CoA Associated cardiac defects - Bicuspid aortic valve - VSD with/without repair - Isthmus/arch hypoplasia - Aortic stenosis - Others Syndromes
22/11 21 (0.05-67.5) 19 (58%) 8 (24%) 25 (76%) 5 (15%) 8 (24%) 10 (33%) 11 (33%) 15 (45%) 6 (18%) *
Shone's syndrome, Tumer's syndrome, Wolff-Parkinson-White syndrome, William's syndrome, M. Recklinghausen, unknown syndrome. CoA=coarctation of the aorta, VSD=ventricular septal defect. *
defined as diameter ofthe coarctation segment
Immediate and intermediate results of stent
therapy for aortic coarctation
A.M. Honing-Hemmers, W.K van Putten, M. Gewillig, G. Mast, M. Talsma, R. Tanke, D. de Wolff, N. Sreeram
Objectives. The aim of the study was to assess the immediate and intermediate outcomes of stent therapy for coarctation or recoarctation of the aorta.
Setting. Terdary referral centres. Methods. A case review of all patients who have undergone stent implantation for coarctation of aorta in the Netherlands and Belgium. Results. Stents were implanted in 33 patients (mean age 21±16 years) and successfill outcome occurred acutely in 32 of these 33 patients. Peak systolic blood pressure decreased from 149±37 to 124±24 mmHg. The pressure gradient decreased from 37± 16 to 7±7 mmHg. The diameter of the coarctation segment increased from 7.3±3.8 to 13.3*3.9 mm. Three patients had major complications and three had minor complications. During a mean follow-up of 21*17 months recoarctation was found in ten patients, seven of whom have undergone fiurther procedures. There were no deaths at follow-up. A.M. HonlngHommers. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht. W.K. van Puten. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht.
0. Mast. Department of Cardiology, Wilhelmina Children's Hospital, Utrecht. N. Sram. Department of Cardiology, Wilhelmina Children's Hospital,
Utrecht. M. Gow1114g
University Hospital Leuven, Belgium.
M. Talsma.
University Hospital Groningen. R. Tanks.
University Hospital N,jmegen. D. de Wolff.
University Hospital Gent, Belgium. Address for correspondence: N. Sreeram. E-mail: [email protected]
Nctherlands Heart Journal, Volume 11, Number 6, June 2003
Conclusions. Stent implantation is a good alternative to balloon dilation in selected patients with coarctation of the aorta. However, follow-up evaluation reveals a varying incidence of recoarctation and the long-term outcomes need to be determined. (Neth HeartJ 2003;1 1:245 -9.) Keywords: aortic coarctation, stent implantation S tent therapy has been advocated for coarctation of the aorta, both native and following previous balloon dilation or surgery (recoarctation). There are few large series describing the results of stent implantation for coarctation, and most of them are single-institution studies.'14 We report the immediate and intermediate results ofstent therapy for coarctation of the aorta from all paediatric cardiac centres in the Netherlands and Belgium where stent implantation has been undertaken. One infant aged 6 months, in whom stent implantation resulted in death, has been exduded from this study. That patient's case is currently the subject of a judicial enquiry, and it was felt to be inappropriate to comment further on the indications, results and outcomes ofthe procedure in order not to prejudice either the enquiry or the participants in that procedure. Methods Protocol The participating centres for the studywere Groningen, Nijmegen and Utrecht in the Netherlands, and Gent and Leuven in Belgium. Data regarding patients' clinical status were collected by chart review. Institutional review board approval was obtained for followup studies on all patients reported here. Patient confidentiality was maintained during data analysis and manuscript preparation. Coarctation of the aorta was defined as systolic arm-to-leg blood pressure gradient .20 mmHg and confirmed by echocardiographic (n=33), magnetic resonance (n=18) and/or angiographic imaging (and
245
Immediate and intermediate results of stent therapy for aortic coarctation
Tabe 1. Characteristics of the patients (n=33). Male/female Age (years) Hypertension Isolated CoA Associated cardiac defects - Bicuspid aortic valve - VSD with/without repair - Isthmus/arch hypoplasia - Aortic stenosis - Others Syndromes
22/11 21 (0.05-67.5) 19 (58%) 8 (24%) 25 (76%) 5 (15%) 8 (24%) 10 (33%) 11 (33%) 15 (45%) 6 (18%) *
Shone's syndrome, Tumer's syndrome, Wolff-Parkinson-White syndrome, William's syndrome, M. Recklinghausen, unknown syndrome. CoA=coarctation of the aorta, VSD=ventricular septal defect. *
defined as diameter ofthe coarctation segment
