Effect of stent implantation on blood pressure control in adults with coarctation of the aorta

Burg, Jennifer J. van der; Warmerdam, Evangeline G; Krings, Gregor; Meijboom, Folkert J.; Dijk, Arie P.J. van; Post, Marco C.; Veen, Gerrit; Voskuil, Michiel; Sieswerda, Gertjan T.

doi:10.1016/j.carrev.2018.03.018

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Over the decades, the interventional stenting technology has achieved very fruitful clinical results in treatment of COA, [ 12 , 14 , 20 , 21 ] and has become the treatment of first choice in adults in many centers [ 22 ]. However, the stents are not suitable for the coarctation located at the arch of which the curvature is too sharp.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies

Lin

Chang

Qian

et al. 2022

BMC Cardiovasc Disord

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Objective One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent (hybrid). Methods Between January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results. Results All the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5 ± 14.0 years which was older than hybrid group (27.9 ± 8.5 years, P = 0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4 to 119.7 mmHg and 148.4 to 111.6 mmHg, the median peak systolic gradient decreased from 68.0 to 10 mmHg and 46.5 to 10 mmHg respectively (P = 0.09). And the mean upper-lower limbs gradient decreased from 21.7 to 5.9 mmHg and 21.0 to 2.7 mmHg respectively (P = 0.104). The mean follow-up time was 76.92 ± 18.7 in bypass group and 85.4 ± 20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups. Conclusions The bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.

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Section: Discussionmentioning

confidence: 99%

Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies

Lin

Chang

Qian

et al. 2022

BMC Cardiovasc Disord

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Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience

Homsi¹,

Khoury²,

Hmedeh³

et al. 2022

Cardiovascular Revascularization Medicine

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Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis

Meijs

Warmerdam

Slieker

et al. 2019

Heart

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ObjectiveLong-term prognosis of patients with coarctation of the aorta (CoA) is impaired due to the high prevalence of hypertension and consequent cardiovascular complications. Although stent implantation results in acute anatomical and haemodynamic benefit, limited evidence exists regarding the late clinical outcome. In this meta-analysis, we aimed to evaluate the medium-term effect of stent placement for CoA on systemic blood pressure (BP).MethodsPubMed, EMBASE and Cochrane databases were searched for non-randomised cohort studies addressing systemic BP ≥12 months following CoA stenting. Meta-analysis was performed on the change in BP from baseline to last follow-up using a random-effects model. Subgroup analyses and meta-regression were conducted to identify sources of heterogeneity between studies.ResultsTwenty-six studies with a total of 1157 patients and a median follow-up of 26 months were included for final analysis. Meta-analysis showed a 20.3 mm Hg (95% CI 16.4 to 24.1 mm Hg; p<0.00001) reduction in systolic BP and an 8.2 mm Hg (12 studies; 95% CI 5.2 to 11.3 mm Hg; p<0.00001) reduction in diastolic BP. A concomitant decrease in the use of antihypertensive medication was observed. High systolic BP and peak systolic gradient at baseline and stenting of native CoA were associated with a greater reduction in systolic BP at follow-up.ConclusionsStent implantation for CoA is associated with a significant decline in systolic and diastolic BP during medium-term follow-up. The degree of BP reduction appears to be dependent on baseline systolic BP, baseline peak systolic gradient, and whether stenting is performed for native or recurrent CoA.

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Effect of stent implantation on blood pressure control in adults with coarctation of the aorta

Cited by 4 publications

References 31 publications

Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies

Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies

Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience

Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis

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