The Choice of Optimally Necessary Devices for Endovascular Treatment of Coarctation of the Aorta

  • Bogdan V. Cherpak National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-9956-0432
  • Nataliia S. Yaschuk National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-1993-5167
  • Yuliia V. Yermolovych National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-9723-1339
  • Oleksandr S. Golovenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-6002-3325
  • Yuriy V. Panichkin National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
DOI: https://doi.org/10.30702/ujcvs/22.30(04)/CY062-6672
Keywords: recoarctation, discrete coarctation of the aorta, endovascular stenting, stent-grafts, open-cell stents, closed-cell stents, congenital heart defects

Abstract

The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient.

Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed.

Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years.

Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.

References

  1. Lazoryshynets VV, Yemets IM. Istorychni vikhy khirurhii dytiachykh serdets [Milestones in Pediatric Heart Surgery]. Cardiology and cardiac surgery: continuous professional development. 2019;(1):7-11. Ukrainian.
  2. Backer CL, Kaushal S, Mavroudis C. Coarctation of the aorta. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 4th ed. Hoboken (NJ): Wiley-Blackwell;2013. p. 256-82.
  3. Balci A, Sollie-Szarynska KM, van der Bijl AG, Ruys TP, Mulder BJ, Roos-Hesselink JW, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart. 2014;100(17):1373-81. https://doi.org/10.1136/heartjnl-2014-305597
  4. Bhatt AB, Defaria Yeh D. Long-term outcomes in coarctation of the aorta: An evolving story of success and new challenges. Heart. 2015;101(15):1173-5. https://doi.org/10.1136/heartjnl-2015-307641
  5. Bondanza S, Calevo MG, Marasini M. Early and Long-Term Results of Stent Implantation for Aortic Coarctation in Pediatric Patients Compared to Adolescents: A Single Center Experience. Cardiol Res Pract. 2016;2016:4818307. https://doi.org/10.1155/2016/4818307
  6. Brzezinska-Rajszys G. Stents in treatment of aortic coarctation and recoarctation in small children. Int J Cardiol. 2018;263:40-1. https://doi.org/10.1016/j.ijcard.2018.03.141
  7. Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart. 2017;103(15):1148-55. https://doi.org/10.1136/heartjnl-2017-311173. Erratum in: Heart. 2019 Jul;105(14):e6.
  8. Fox EB, Latham GJ, Ross FJ, Joffe D. Perioperative and Anesthetic Management of Coarctation of the Aorta. Semin Cardiothorac Vasc Anesth. 2019;23(2):212-24. https://doi.org/10.1177/1089253218821953
  9. Gewillig M, Budts W, Boshoff D, Maleux G. Percutaneous interventions of the aorta. Future Cardiol. 2012;8(2):251-69. https://doi.org/10.2217/fca.12.10
  10. Hoffman JI. The challenge in diagnosing Coarctation of the aorta. Cardiovasc J Afr. 2018;29(4):252-5. https://doi.org/10.5830/CVJA-2017-053
  11. Kaya U, Colak A, Becit N, Ceviz M, Kocak H. Surgical Management of Aortic Coarctation from Infant to Adult. Eurasian J Med. 2018;50(1):14-8. https://doi.org/10.5152/eurasianjmed.2017.17273
  12. Kenny D, Hijazi ZM. Coarctation of the aorta: from fetal life to adulthood. Cardiol J. 2011;18(5):487-95. https://doi.org/10.5603/cj.2011.0003
  13. Kipps AK, Olson I, Purkey N, Reddy C. Pediatric Cardiac Acute Care Handbook. 2nd ed. 2018-2019. p. 92-94.
  14. Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R; COAST Investigators*. Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation. 2015;131(19):1656-64. https://doi.org/10.1161/CIRCULATIONAHA.114.013937
  15. Rogers C, Clawson RE. Coarctation of the aorta. JAAPA. 2019;32(6):46-7. https://doi.org/10.1097/01.JAA.0000558245.81325.02
  16. Sohrabi B, Jamshidi P, Yaghoubi A, Habibzadeh A, Hashemi-Aghdam Y, Moin A, et al. Comparison Between Covered and Bare Cheatham-Platinum Stents for Endovascular Treatment of Patients With Native Post-Ductal Aortic Coarctation: Immediate and Intermediate-Term Results. JACC Cardiovasc Interv. 2014;7(4):416-23. https://doi.org/10.1016/j.jcin.2013.11.018
  17. Suradi H, Hijazi ZM. Current management of Coarctation of the aorta. Glob Cardiol Sci Pract. 2015;2015(4):44. https://doi.org/10.5339/gcsp.2015.44
  18. Torok, RD., Campbell, MJ., et al. Coarctation of the aorta:Management from infancy to adulthood. World J Cardiol. 2015;7(11):765-75. https://doi.org/10.4330/wjc.v7.i11.765
  19. Vergales JE, Gangemi JJ, Rhueban KS, Lim DS. Coarctation ofthe Aorta - The Current State of Surgical and Transcatheter Therapies. Curr Cardiol Rev. 2013;9(3):211-9. https://doi.org/10.2174/1573403x113099990032
Published
2022-12-26
How to Cite
Cherpak, B. V., Yaschuk, N. S., Yermolovych, Y. V., Golovenko, O. S., & Panichkin, Y. V. (2022). The Choice of Optimally Necessary Devices for Endovascular Treatment of Coarctation of the Aorta. Ukrainian Journal of Cardiovascular Surgery, 30(4), 66-72. https://doi.org/10.30702/ujcvs/22.30(04)/CY062-6672
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 4 2022
Section
CONGENITAL HEART DEFECTS