Page 39 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Background: Stent implantation (SI) is more e ective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to the large sheath size required for SI and requirement for repeat intervention, balloon angioplasty is more commonly performed in small patients. We sought to evaluate the medium and long-term outcomes of per- cutaneous adult-sized SI for the treatment of CoA in small patients.
Methods: A single center retrospective review of all patients ≤ 20 kilograms who underwent adult-sized percu- taneous SI for CoA was performed.
Results: From 2004-2015, 39 patients ≤ 20 kilograms (21 patients ≤ 10kgs) underwent percutaneous SI for CoA. The majority of lesions were recurrent (74%) that failed balloon angioplasty (56%). 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] kilograms. Stents used included: Palmaz Genesis XD (n=32), eV3 Mega LD (n=2), eV3 Max LD (n=2), Palmaz XL (n=2), and premounted Valeo (n=1). SI resulted in signi cant improvements in both coarctation diame- ter [mean±standard deviation] (4.0±2.0 mm to 8.2±2.2 mm, p=<0.05) and gradient (32.3±18.2 mmHg to 0.9±1.5 mmHg, p=<0.05). Most stents were delivered through a 6 French (n=13) or 7 French (n=12) sheath (range 6-10 French). Seven patients had 7 (18%) complications: arterial vascular access site injury (n=3), vascular injury at site of CoA (n=2), intraprocedural hypotension and bradycardia (n=1), and stent embolization (n=1). No patient required surgical intervention at the site of vascular access or stented CoA. Mean follow-up was 75.6±46.5 months. Twenty- ve (64%) patients have undergone elective re-intervention at a mean time of 42.7±33.7 months from original stent implantation. Eight (21%) stents (all Palmaz Genesis XD) developed fractures which were successfully treated with coaxial SI. In follow-up, femoral arterial occlusion has been documented in 2/16 (13%) patients.
Conclusions: Adult-sized SI is a viable option for small patients with either native or recurrent CoA with increased risk of vascular access complications. As with all stents implanted in children, repeat intervention is expected as the patient grows. Longer-term follow-up into adulthood is needed.
54. THE EFFECTIVENESS OF BALLOON ANGIOPLASTY OF NATIVE COARCTATION OF THE AORTA
IN NEWBORNS AND SMALL INFANTS - OWN EXPERIENCE
Jacek Kusa1,2, Pawel Czesniewicz2, Agnieszka Skierska1,
Malgorzata Ras2
1Medical University of Silesia, Pediatric Cardiology Department,
Katowice, Poland. 2Regional Specialized Hospital, Pediatric Cardiology Department, Wroclaw, Poland
Introduction: Balloon angioplasty of coarctation of the aorta in children is an accepted method of treatment but is not recommended in patients under six months of age because of the signi cant risk of early recoarctation.
The aim of study is to evaluate the e ectiveness of this method in newborns and youngest infants.
Material/Methods: Between 01.03.2011 and 10.04.2018 balloon angioplasties of aortic coarctation were performed in 24 patients aged between 6 and 149 days (mean-73±53). Only patients with naïve form of coarctation were qual- i ed. There were 9 newborns (37,5%). Nine patients had a bicuspid aortic valve. Eight patients (33.3%) had critical form of coarctation (heart failure), six (25%)- patent ductus arteriosus (Prostin in 2).
Results: After procedure the stenosis diameter increased from 1.8 (0,4-2,8) to 4.0mm (1,9-6,2)mm. The maximum echocardiographic gradient decreased from 70.1 (48-120) mmHg to 27,9 (15-38)mmHg, average from 36,7 (21-62) mmHg to 11,2 (6-17)mmHg, and hemodynamic gradient from 35.4 (6-69) to 9.3mmHg (1-30)mm Hg. There were complications associated with procedure- limb ischemia in two cases (8,3%), In one- the normal blood ow returned after heparin administration. In the second patient, despite heparin and actylise the pulse did not returned, but the e cient collateral circulation developed.
During FU- 40±24 (1-83) months 6 patients required some intervention (one more child is currently awaiting the date of surgery). Three patients (12,5%) required surgical plasty (1 month after angioplasty) because of the ine ectiveness of percutaneous intervention, in another 3 patients the treatment was e ective, but during FU stenosis returned and after 18 (6-36) months the successful repeated balloon angioplasty was performed. In the remaining patients the good e ect of treatment is still present.
Conclusions: Percutaneous angioplasty of aortic coarc- tation in the youngest age groups may be an e ective treatment, alternative for cardiac surgery. The incidence of recoarctation during medium-term FU does not di er signi cantly from cardiac surgery and can be successfully treated by repeated percutaneous angioplasty.
Hijazi, Z
21st Annual PICS/AICS Meeting