Stenting of aortic coarctation: Acute, intermediate, and long-term results of a prospective multi-institutional registry-Congenital cardiovascular interventional study consortium (CCISC)

Ralf Holzer, Shakeel Qureshi, Abdolrahim Ghasemi, Julie Vincent, Horst Sievert, Daniel Gruenstein, Howard Weber, Luis Alday, Alejandro Peirone, Thomas Zellers, John Cheatham, Michael Slack, Jonathan Rome

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

Introduction: Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection. Methods: Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention. Results: Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n = 1 and aneurysm n = 3). Other adverse events (n = 15) occurred mainly acutely and included technical complications such as stent malposition (n = 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication. Conclusions: This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention.

Original languageEnglish (US)
Pages (from-to)553-563
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume76
Issue number4
DOIs
StatePublished - Oct 1 2010

Keywords

  • coarctation
  • congenital heart disease in adults
  • pediatric interventions

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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