From bare to covered: 15-year single center experience and follow-up in trans-catheter stent implantation for aortic coarctation.
BACKGROUND
Bare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice.


OBJECTIVE
The present study, reports comparatively 15-year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center.


METHODS
From 1997 to 2011, 143 patients with native or postoperative aortic coarctation were treated at our institution. Seventy-one subjects (median age 17 years (range from 4 to 70 years) underwent bare stent implantation (Group 1) while 72 patients (median age of 17.5 years (range from 6 to 68 years) underwent covered stent implantation (Group 2).


RESULTS
Success rate in the whole group was 95%. More complex and tighter coarctations were treated using covered stents. Incidence of related-procedure adverse events was higher in Group 1 than in group 2 (21.1% vs. 8.3% P = 0.035). Aortic wall complications occurred in 7% of patients in Group 1 (one death) and 0% in Group 2 (P = 0.028). Subjects in Group 1 had a longer follow-up (median 85 vs. 35 months; P < 0.001). Independent predictors associated with reintervention included the presence of complex lesions (HR: 2.70; CI: 1.15-6.32), balloon diameter used <14 mm (HR: 3.76; CI: 1.48-9.55), and immediate residual gradient >10 mm Hg (HR: 4.30; CI: 1.96-9.47).


CONCLUSIONS
Both bare and covered stent implantation for aortic coarctation is a safe and efficacious treatment. By using covered stent implantation the spectrum of patients treated has increased with lower rates of acute and late complications.
Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Policlinico San Donato IRCCS, Milan, Italy.
Gianfranco
G
Butera
João Luiz Langer
JL
Manica
Davide
D
Marini
Luciane
L
Piazza
Massimo
M
Chessa
Raul Ivo Rossi
RI
Filho
Rogério E
RE
Sarmento Leite
Mario
M
Carminati
D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000175:diagnosis / Q000628:therapy*; D001027:Aortography; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
aortic coarctation; stent; transcatheter; treatment