TY - JOUR
T1 - Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study
AU - Shahanavaz, Shabana
AU - Aldoss, Osamah
AU - Carr, Kaitlin
AU - Gordon, Brent
AU - Seckeler, Michael D.
AU - Hiremath, Gurumurthy
AU - Seaman, Cameron
AU - Zablah, Jenny
AU - Morgan, Gareth
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/11
Y1 - 2020/11
N2 - Objectives and Background: Coarctation of the aorta represents 5–8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort. Methods: TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. Results: Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days–42 years), median weight 54 kg (1.1–141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0–57 mmHg) to 0 mmHg (0–23 mmHg) (p <.001). The narrowest arch diameter increased from 9 mm (1.4–16 mm) to 14 mm (2.9–25 mm) (p <.001), with a median increase of 4.9 mm (1.1–10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4–7.3 years). Conclusions: TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.
AB - Objectives and Background: Coarctation of the aorta represents 5–8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort. Methods: TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. Results: Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days–42 years), median weight 54 kg (1.1–141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0–57 mmHg) to 0 mmHg (0–23 mmHg) (p <.001). The narrowest arch diameter increased from 9 mm (1.4–16 mm) to 14 mm (2.9–25 mm) (p <.001), with a median increase of 4.9 mm (1.1–10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4–7.3 years). Conclusions: TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.
KW - coarctation of aorta
KW - stent placement
KW - transverse aorta
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U2 - 10.1002/ccd.29248
DO - 10.1002/ccd.29248
M3 - Article
C2 - 32902911
AN - SCOPUS:85090431716
SN - 1522-1946
VL - 96
SP - 1277
EP - 1286
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -