Key result
Percutaneous stenting with new generation low-profile stents in children under 30 kg with aortic coarctation significantly reduced the median pressure gradient from 35.0 to 5.0 mmHg without significant complications.
Why the study?
Following previous reporting of short-term outcomes, medium-term outcomes of stenting aortic coarctation with newer generation low-profile stents in children under 30 kg remained to be determined.
Does percutaneous stenting with low-profile stents provide safe and effective medium-term outcomes in children under 30 kg with aortic coarctation?
Observational (n=19)
No
Does percutaneous stenting with low-profile stents provide safe and effective medium-term outcomes in children under 30 kg with aortic coarctation?
Percutaneous stenting with low-profile stents is a safe and effective medium-term treatment for aortic coarctation in children under 30 kg, though a quarter of patients may require re-intervention or ongoing anti-hypertensive therapy.
Answers are grounded in this paper and cite their sources.
May support low-profile stenting for medium-term relief in small children with coarctation; leaves open need for randomized trials on durability.
We previously reported short-term outcomes for stenting of aortic coarctation (CoA) (native or re-coarctation) with newer generation low-profile stents (Valeo, Formula, and Begraft stents) in children under 30 kg. We present here the medium-term outcomes of this procedure. Retrospective review of patients weighing under 30 kg who had percutaneous stent treatments for coarctation between 2012 and 2021 was performed. Clinical and procedural data were collected; 19 patients were included. The median age at the time of procedure was 5.1 [4.1–6.4] years and median weight 21.0 [17.3–22.3] kg. One patient had a history of re-coarctation. Thirteen (68%) patients were on anti-hypertensives pre-procedure. Different types of stents were used (14 Valeo™, 4 Formula® 535, 1 BeGraft), which can all be dilated to 18 mm or larger. One patient required a 9 F sheath, all others required a 7 F sheath. The narrowest diameter in the aorta increased from a median of 3.5 [3.0–4.5] to 9.4 [8.9–9.8] mm, p < 0.001; there was a reduction in the median pressure gradient across the coarctation from 35.0 [30.0–43.0] to 5.0 [0–10.0] mmHg, p < 0.001. There were no intra-procedural complications. Follow-up was for a median of 56.0 [13.0–65.0] months. Five (26%) of patients underwent re-intervention after a median time frame of 40.0 [39.5–52.0] months; four had balloon dilation, one had repeat stent implantation. Five (26%) patients were on anti-hypertensive agent(s) post-intervention. Our single centre experience demonstrates that percutaneous stenting for coarctation of aorta in children under 30 kg, with low-profile stents, had no significant complications during the median follow-up time of 56 months. This study demonstrated that the procedure is safe and effective for short and medium-term therapy in this group of patients with a 26% re-intervention rate. A quarter of patients remained on anti-hypertensive medication post stenting, emphasizing the importance of long-term follow-up.
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Gibb et al. (2024) conducted an observational in Aortic coarctation (n=19). New generation low-profile stents (Valeo, Formula 535, BeGraft) vs. Pre-intervention baseline was evaluated on Median pressure gradient across the coarctation (mmHg) (p=<0.001). Percutaneous stenting with new generation low-profile stents in children under 30 kg with aortic coarctation significantly reduced the median pressure gradient from 35.0 to 5.0 mmHg without significant complications.
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