Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates.
BACKGROUND
Surgical repair of critical coarctation can be problematic in premature, critical, complex, or early postoperative neonates.


OBJECTIVE
We aimed to review our experience with stent implantation to defer urgent surgery to an elective time.


METHODS
Fifteen neonates with severe aortic coarctation: five premature-hypotrophic (1,400-2,000 g), six critical and complex cardiac malformation, four early (1 day [0-2 days]; median [range]) after surgical coarctectomy or complex arch reconstruction. Bare coronary stents (diameter 4.0 [3.5-5.0] mm; length 10 [8-16] mm) were used. Stents were removed surgically depending on clinical needs.


RESULTS
Adequate aortic flow was obtained in 15 patients. The femoral artery was preserved in 13/15 patients. Two deaths occurred before stent removal and were nonprocedure related. In patients with simple stented coarctation, the stent was removed after 2.8 [0.2-5.0] months. In complex cardiac malformation, stents were finally removed 3.0 [0.2-78] months after implantation.


METHODS
simple coarctectomy end-to-end in eight, extensive arch patch reconstruction in four. One patient is awaiting stent removal. The final maximum systolic velocity (cw-Doppler) across the aortic arch was 1.7 [1.2-2.5] m/sec.


CONCLUSIONS
In premature/critical/complex neonates with severe coarctation, bailout stenting followed by early or late surgical coarctectomy appears a promising concept.
Paediatric Cardiology, University Clinic Leuven, Leuven B 3000, Belgium.
Matthias
M
Gorenflo
Derize E
DE
Boshoff
Ruth
R
Heying
Benedicte
B
Eyskens
Filip
F
Rega
Bart
B
Meyns
Marc
M
Gewillig
D001017:Aortic Coarctation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D016638:Critical Illness; D020878:Device Removal; D015150:Echocardiography, Doppler; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome