Stenting of the Aorta for Native and Recurrent Coarctation in Patients up to 5 Years

Background: Young children with native coarctation (CoA) are treated surgically. However, reoperations for recurrent CoA are demanding. Furthermore, associated anomalies may present a contraindication for surgery.

CoA stenting may be an alternative treatment option in these patients. We present our results after CoA stenting in children up to 5 years of age.

Method: Retrospective study of all consecutive patients (age <5 years) undergoing CoA stenting at the German Heart Center Munich.

Results: Seventy-seven patients (male: 48, median age: 5.0 [min.: 0; max.: 52] months; median weight: 5.9 [min.: 0.9; max.: 14.7] kg) were included. Indications were a native CoA with relative contraindications for surgery in 6, and a re-CoA after surgery in 71 patients. Re-CoA diagnoses included 31 (44%) patients after Norwood procedure, 22 (31%) patients with complex arch reconstruction, and 18 (25%) after CoA resection with end-to-end anastomosis. Eighty stents were implanted (coronary stent = 2, baby stent  = 4, formula stent = 75, Mega LD = 1). Unsuccessful balloon angioplasty had been performed in 15 patients before stent implantation.

All procedures were successful. The median systolic gradient declined significantly and was below 20 mm Hg in all patients after the procedure. The stenosed aortic diameter increased significantly. In 19 patients, the left subclavian artery was covered by the stent and reopened in 4 by balloon angioplasty. There were no serious complications. During follow-up, 19 patients required redilatation and 8 patients required restenting with a larger stent.

Conclusion: Percutaneous stenting of the aorta for Re-CoA and in selected patients with native CoA is feasible and safe, even in children under 5 years of age. However, repeated stent redilatation and later interventional cracking of the stent with a larger stent and ultra-high pressure balloons is necessary to augment the aorta in size.

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Artikel online veröffentlicht:
28. Januar 2023