open access

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Original articles
Published online: 2017-06-01
Submitted: 2017-01-28
Accepted: 2017-05-11
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Implantation of stents for postsurgical recoarctation of the aorta in adolescents and adults

Sylwia Sulik-Gajda, Roland Fiszer, Jacek Białkowski, Beata Chodór, Szymon Pawlak, Małgorzata Szkutnik
DOI: 10.5603/KP.a2017.0114

open access

Ahead of print
Original articles
Published online: 2017-06-01
Submitted: 2017-01-28
Accepted: 2017-05-11

Abstract

Background: Results of stent implantation (SI) of postsurgical recoarctation of the aorta (ReCoA) are not frequently published.

Aim: This study sought to retrospectively evaluate results of SI in ReCoA in older children and adults.

Methods: Twenty-eight SI were performed on 26 ReCoA patients with a median age of 23(10-65) years. Dependent upon availability, the following stents were applied -Palmaz, Cheatham Platinum (CP), Andrastents XL/XXL(AS), Covered CP (CVCP) stents and selfexpanding stents (Smart). Generally high pressure balloons were applied to dilate stents.

Results: The procedure was effective in 20/26 patients (77,7%). The mean  peak systolic gradient reduced from 40,5+/- 18,7 mmHg to 13,1+/- 12,1 mm Hg (p<0,05) and the diameter of  stenosed segment increased from 7,5+/- 3.02 mm to 13,1 +/- 3,32 mm  (p<0,05). In 6 cases (including a patient treated with a Smart stent) transaortic pressure gradient after SI remained >20 mm Hg (stiff postsurgical lesion). For one patient (40 year old male), an acute dissection of the aorta occurred during balloon predilatation. Immediate CVCP implantation resolved this problem. Two more CVCP were used – one to close a small aortic aneurysm which appeared 5 years after a Palmaz SI and one other to stabilize a broken CP bare metal stent. There were no deaths nor the aortic dissection during follow-up and most patients were able to reduce or suspend their medication for systemic hypertension.

Conclusions: Endovascular stenting of recoarctation of the aorta in adults and adolescents appears to be an acceptable method of treatment in experienced hands. However, for some patients the presence of a stiff lesion can provoke suboptimal results. Considering the serious complications which may occur after SI, following surgery all patients should have regular follow up (including an imaging study). Covered stents should always be available in the cathlab as a rescue device when implanting stents in CoA patients.

Abstract

Background: Results of stent implantation (SI) of postsurgical recoarctation of the aorta (ReCoA) are not frequently published.

Aim: This study sought to retrospectively evaluate results of SI in ReCoA in older children and adults.

Methods: Twenty-eight SI were performed on 26 ReCoA patients with a median age of 23(10-65) years. Dependent upon availability, the following stents were applied -Palmaz, Cheatham Platinum (CP), Andrastents XL/XXL(AS), Covered CP (CVCP) stents and selfexpanding stents (Smart). Generally high pressure balloons were applied to dilate stents.

Results: The procedure was effective in 20/26 patients (77,7%). The mean  peak systolic gradient reduced from 40,5+/- 18,7 mmHg to 13,1+/- 12,1 mm Hg (p<0,05) and the diameter of  stenosed segment increased from 7,5+/- 3.02 mm to 13,1 +/- 3,32 mm  (p<0,05). In 6 cases (including a patient treated with a Smart stent) transaortic pressure gradient after SI remained >20 mm Hg (stiff postsurgical lesion). For one patient (40 year old male), an acute dissection of the aorta occurred during balloon predilatation. Immediate CVCP implantation resolved this problem. Two more CVCP were used – one to close a small aortic aneurysm which appeared 5 years after a Palmaz SI and one other to stabilize a broken CP bare metal stent. There were no deaths nor the aortic dissection during follow-up and most patients were able to reduce or suspend their medication for systemic hypertension.

Conclusions: Endovascular stenting of recoarctation of the aorta in adults and adolescents appears to be an acceptable method of treatment in experienced hands. However, for some patients the presence of a stiff lesion can provoke suboptimal results. Considering the serious complications which may occur after SI, following surgery all patients should have regular follow up (including an imaging study). Covered stents should always be available in the cathlab as a rescue device when implanting stents in CoA patients.

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Keywords

coarctation of aorta; recoarctation; stenting

About this article
Title

Implantation of stents for postsurgical recoarctation of the aorta in adolescents and adults

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Ahead of print

Published online

2017-06-01

DOI

10.5603/KP.a2017.0114

Keywords

coarctation of aorta
recoarctation
stenting

Authors

Sylwia Sulik-Gajda
Roland Fiszer
Jacek Białkowski
Beata Chodór
Szymon Pawlak
Małgorzata Szkutnik

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