Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates

Abstract

Background: Surgical repair of critical coarctation can be problematic in premature, critical, complex, or early postoperative neonates. Objectives: We aimed to review our experience with stent implantation to defer urgent surgery to an elective time. Methods: Fifteen neonates with severe aortic coarctation: five premature-hypotrophic (1,400-2,000 g), six critical and complex cardiac malformation, four early (1

The use of small stents to delay surgical intervention in very young children with critical congenital heart disease

“…Reported success rate ranges between 80% -100%. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Our findings compare favourably with this. Overall, low periprocedural complication rates have been reported in stents used in older children (up to 16%).…”

“…Later complications include intrastent proliferation, restenosis and occlusion (3-36%). (5,10,12,25,31) There were no periprocedural deaths in the study group and complications were mild and few: dysrhythmias (n=2) and stent migration (n=1). The latter occurred in patient 11.…”

“…However, as the group of patients is quite diverse, it is difficult to compare the overall mortality to a similar surgical series. (3)(4)(5)(6)(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Mortality in surgical COA repairs in infants for example, is known to be much lower (<2%), but higher in small, complex patients (5 -25%). (3,12) It should be mentioned that one patient was sent home for palliative care and one patient had severe post-operative hypoxia and acidosis.…”

“…Primary surgical repair is the treatment of choice in newborns with COA. (10) Primary surgical repair and redo surgeries in critically ill patients are risky and there is a higher rate of recoarctation (10% -29%) in very small and premature infants. Also, COA associated with other lesions and complicated by left ventricular dysfunction and cardiorespiratory decompensation, may adversely affect surgical outcomes.…”

“…(14) Experience in stenting very young and small patients with critical obstructive congenital heart disease is limited and consists mostly of case reports and a few review articles. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) The majority reported good immediate results, but limited data on follow-up and final outcomes is available.…”