Self-expanding and balloon expandable covered stents in the treatment of aortic coarctation with or without aneurysm formation.
OBJECTIVE
We describe our complete experience with covered stent implantation for aortic coarctation including short- to medium-term outcomes.


BACKGROUND
Coarctation of the aorta is a heterogeneous disease process with multiple associated complications both with and without treatment. Covered stents have evolved to provide greater support to the aortic wall and a varied approach with choice of stent tailored to the anatomy of the patient is required.


METHODS
We retrospectively analyzed consecutive patient data from two congenital heart centers from March 2003 to October 2007.


RESULTS
We implanted 38 covered stents in 37 patients (20 female) of which three were self-expanding stents. Median age was 29.6 years (9-65) with median weight of 71.5 kg (35-95). The indications for stent placement were native coarctation (n = 13); recurrent coarctation following surgical treatment (n = 11); aneurysm associated with previous coarctation surgery (n = 7); aorto-bronchial fistula leading to acute hemoptysis (n = 2); stent fracture (n = 1); associated arterial duct (n = 2). One patient had a combination of acquired coarctation and false aneurysm. The median screening time was 10 min (3-22). The median systolic gradient of 26 mm Hg (10-60) was reduced to 4 mm Hg (0-20) postprocedure (P < 0.001). There were no deaths on median follow up of 11.5 months (1-56). One patient developed aortic rupture during the procedure and required emergency surgery.


CONCLUSIONS
Covered stent implantation for treatment of aortic coarctation is safe and highly effective in selected patients. Self-expanding stent grafts may be preferable to balloon expandable stents when there is aneurysm formation in the setting of aortopathy.
Kenny
Damien
D
Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, Bristol, United Kingdom.
Margey
Ronan
R
Turner
Mark S
MS
Tometzki
Andrew J
AJ
Walsh
Kevin P
KP
Martin
Robin P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001014:Aortic Aneurysm / Q000150:complications* / Q000628:therapy; D001017:Aortic Coarctation / Q000150:complications* / Q000628:therapy*; D002648:Child; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D011091:Polyesters; D011138:Polytetrafluoroethylene