Comparison of Surgical, Stent, and Balloon Angioplasty Treatment of Native Coarctation of the Aorta

Forbes, Thomas J.; Kim, Dennis W.; Du, Wei; Turner, Daniel R.; Holzer, Ralf; Amin, Zahid; Hijazi, Ziyad M.; Ghasemi, Abdolrahim; Rome, Jonathan J.; Nykanen, David; Zahn, Evan M.; Cowley, Charles R.; Hoyer, Mark V.; Waight, David J.; Gruenstein, Daniel H.; Javois, Alexander J.; Foerster, Susan; Kreutzer, Jacqueline; Sullivan, Nancy; Khan, Asra; Owada, Carl Y.; Hagler, Donald J.; Lim, Scott; Canter, Joshua; Zellers, Thomas M.

doi:10.1016/j.jacc.2011.08.053

Cited by 283 publications

(90 citation statements)

References 34 publications

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“…Similarly, comparison of this rate with historical surgical results must include the acknowledgment of selection bias with respect to anatomy, age at repair, and many other variables. 1 With this important caveat, reintervention after surgical repair of CoA appears to vary widely, depending on subject size, anatomy, era, and technique of repair. [12][13][14][15][16][17][18][19] Except in unusual situations, there are no planned surgical reinterventions.…”

Section: Clinical and Hemodynamic Outcomes And Reintervention Ratesmentioning

confidence: 99%

“…In contrast, planned reintervention on endovascular stents, either as a part of a staged approach to severe arch obstruction or as a part of stent therapy in growing patients, is well documented. 1,[20][21][22][23][24] Second, and sometimes third, procedures are considered by some to be part of the tradeoff in selected high-risk and younger patients in avoidance of surgery. The prevalence of this practice is unknown, but small and probably increasing proportions of published cohorts include this population of patients.…”

Section: Clinical and Hemodynamic Outcomes And Reintervention Ratesmentioning

confidence: 99%

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Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

et al. 2015

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Background-The Coarctation of the Aorta Stent Trial (COAST) was designed to assess the safety and efficacy of the Cheatham Platinum stent when used in children and adults with native or recurrent coarctation. Acute outcomes have been reported. We report here follow-up to 2 years. Methods and Results-A total of 105 patients underwent attempted implantation, with 104 successes. There were no procedural deaths, serious adverse events, or surgical intervention. All patients experienced immediate reduction in upperto lower-extremity blood pressure difference with sustained improvement to 2 years. Rates of hypertension and medication use decreased from baseline to 12 months and remained largely unchanged at 2 years. Six aortic aneurysms have been identified: 5 were successfully treated with covered stent placement, and 1 resolved without intervention. Stent fractures were noted in 2 patients at 1 year and 11 patients at 2 years, with evidence of fracture progression. To date, only larger stent diameter was associated with stent fracture. Twelve additional fractures have occurred after 2 years. No fracture has resulted in loss of stent integrity, stent embolization, aortic wall injury, or reobstruction. Nine reinterventions occurred in the first 2 years for stent redilation and address of aneurysms, and 10 additional reinterventions occurred after 2 years. Conclusions-The Cheatham Platinum stent is safe and associated with persistent relief of aortic obstruction. Stent fracture and progression of fracture occur but have not resulted in clinically important sequelae. Reintervention is common and related to early and late aortic wall injury and need for re-expansion of small-diameter stents. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00552812.

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Section: Clinical and Hemodynamic Outcomes And Reintervention Ratesmentioning

confidence: 99%

Section: Clinical and Hemodynamic Outcomes And Reintervention Ratesmentioning

confidence: 99%

Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

et al. 2015

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“…Management of coarctation a rate of 9.8% compared to none in the endovascular stent group [69] . In an attempt to more rigorously assess the effectiveness and safety of endovascular stent placement vs surgical repair, a Cochrane review was attempted in 2012, but it was determined that there was insufficient data available to identify the best treatment modality [5] .…”

Section: Balloon Angioplasty: Recurrent Coarctationmentioning

confidence: 96%

“…Exceeding a balloon:coarct ratio of 3.5 and prestent BA increased risk of aortic wall injury Warnes et al [24] --ACC/AHA guidelines for management of coarctation in adults Holzer et al [67] 302 3-60 mo Prospective analysis of acute, intermediate, and long-term follow-up after stent placement for coarctation using CCISC registry. At long-term follow-up, recoarctation in 20% of patients, 4% required unplanned reintervention, and 1% had aortic wall injury Feltes et al [27] --AHA guidelines for transcatheter intervention in children with coarctation Forbes et al [69] 350 Mean 1.7 yr Multicenter observational study comparing surgery, BA, and stent placement for native coarctation in children using CCISC registry. Significantly lower acute complication rates in stent group but higher planned reintervention rates.…”

Section: Follow-up Outcomementioning

confidence: 99%

Coarctation of the aorta: Management from infancy to adulthood

Török

Campbell

Fleming

et al. 2015

WJC

225

145

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Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient's anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

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“…However, this finding is in 9% of patients in previous studies. 17 Moreover, stent placement is not generally recommended in patients weighing less than 25 kg owing to the small aortic size and the potential injury to the femoral artery from the larger sheath required for stent delivery.…”

Section: Long -Term Follow -Upmentioning

confidence: 99%

Immediate and long term outcomes of native aortic coarctation and postsurgical aortic recoarctation treated with stent implantation: one Center experience

Sulik¹,

Fiszer²,

Scalone³

et al. 2017

Polish Archives of Internal Medicine

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INTRODUCTION Stent implantation has become the treatment of choice for native aortic coarctation (CoA) and postsurgical aortic recoarctation (reCoA) in adults and adolescents.OBJECTIVES This study aimed to compare the immediate and long -term outcomes of patients with native CoA and postsurgical reCoA who underwent stent implantation in our center. PATIENTS AND METHODSThe data of 136 patients with native CoA and reCoA who underwent stent implantation between May 1999 and December 2016 were retrospectively analyzed. The study population was divided into 2 groups: 108 patients with native CoA and 28 patients with reCoA. Clinical and procedural characteristics and immediate and long -term outcomes after the intervention were compared between the groups. The use of antihypertensive drugs was analyzed in all patients. RESULTSThere were no significant differences in the clinical characteristics of the study groups. The gradient before the intervention was significantly higher in the native CoA than in the reCoA group (P = 0.011), and the diameter of stenosis before the intervention was smaller in the native CoA group compared with the ReCoA group (P = 0.003). Procedural treatment was successful in 77.8% of the patients with native CoA and 78.5% of those with reCoA. There were no differences in the immediate and long -term outcomes between the groups. The antihypertensive treatment was tapered or discontinued in about 34% of the study population.CONCLUSIONS Stenting is an effective and safe procedure in patients with native CoA and reCoA, with good late outcomes.

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Comparison of Surgical, Stent, and Balloon Angioplasty Treatment of Native Coarctation of the Aorta

Cited by 283 publications

References 34 publications

Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

Coarctation of the aorta: Management from infancy to adulthood

Immediate and long term outcomes of native aortic coarctation and postsurgical aortic recoarctation treated with stent implantation: one Center experience

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