Endovascular treatment of aortic coarctation with a novel BeGraft aortic stent in children and young adults: a single-centre experience with short-term follow-up results

Abstract Objectives: We present our experience and outcomes with the BeGraft in the treatment of aortic coarctation in a predominantly paediatric population. Methods: This study includes a retrospective analysis of patients who had Begraft aortic stent implantation between 2018 and 2020 from a single centre. Results: The BeGraft aortic stent was used in 11 patients (7 males, 4 females) with a median age of 14 (13–21) years and a median weight of 65 (46–103) kg. Coarctation was native in five patients and recurrent in six patients. Median stent diameter and length were 16 mm and 38 mm, respectively. The median peak-to-peak pressure was 30 (12–55) mmHg before the procedure and 5 (0–17) mmHg after the procedure. The stenting procedure was successful in 10 of the 11 patients. Stent migration to the abdominal aorta occurred on post-procedure day 1 in the 21-year-old patient, who had previously undergone surgical closure of the ventricular septal defect and balloon angioplasty for coarctation. After repositioning failed, the stent was safely fixed in the abdominal aorta. Strut distortion also occurred during balloon retrieval in one patient, but no aneurysm or in-stent restenosis was observed at 1-year follow-up. The patients were followed for a median of 14 (4–25) months and none required redilation. Conclusions: Our initial results demonstrated that the BeGraft aortic stent effectively reduced the pressure gradient in selected native and recurrent cases. Despite advantages such as a smaller sheath and low profile, more experience and medium- to long-term results are needed.

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Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey

Cardiology in the Young ◽

10.1017/s1047951113001054 ◽

2013 ◽

Vol 24 (4) ◽

pp. 675-684 ◽

Cited By ~ 6

Author(s):

Ali Baykan ◽

Nazmi Narin ◽

Abdullah Ozyurt ◽

Mustafa Argun ◽

Ozge Pamukcu ◽

...

Keyword(s):

Stent Implantation ◽

Aortic Coarctation ◽

Antihypertensive Drugs ◽

Coarctation Of The Aorta ◽

Arterial Injury ◽

Stent Migration ◽

Long Term Results ◽

Complication Rates ◽

Significant Difference

AbstractObjectives: Our aim was to evaluate patients who were treated by percutaneous stent implantation. Methods: Patients with aortic coarctation (n = 35) who had been treated with 38 stents – 12 bare and 26 covered – were evaluated. The demographics and procedural and follow-up data were recorded from hospital registers and compared according to patient specifications, for example, weight and coarctation nature. Results: The procedure was successful in all patients. There was a statistically significant difference between the patients with native coarctation (n = 17) and those with recurrent coarctation (n = 18) in terms of pre-procedural blood pressures, systolic gradients, coarctation diameters, and the ratio of the coarctation site diameter to the descending aorta diameter. Although all patients received antihypertensive drugs before the procedure, the drug was discontinued in 26 patients during follow-up (p < 0.001). Stent migration was observed in four patients with recurrent coarctation (11.4%), and peripheral arterial injury was seen in three patients (8.5%). The mean follow-up time was 34 ± 16 months. On average, 21 (6–42) months after the procedure, six patients underwent cardiac catheterisation. At least 2 years after the procedure, tomography was performed in 20 patients (57.2%). Patients who were evaluated by multi-slice computerised tomography revealed no pathologies. There was no statistically significant difference between the five patients weighing less than 20 kg and the other 30 patients in terms of demographic and procedural characteristics, procedure success and complication rates, and follow-up data. Conclusion: Stent implantation for aortic coarctation is a method yielding satisfactory results in reducing coarctation gradients, efficient enlargement of the lesion area, and resolution of hypertension for children, including those weighing less than 20 kg.

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Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients

Pediatric Cardiology ◽

10.1007/s00246-020-02456-2 ◽

2020 ◽

Author(s):

M. Bergmann ◽

C. P. Germann ◽

J. Nordmeyer ◽

B. Peters ◽

F. Berger ◽

...

Keyword(s):

Long Term Results ◽

Residual Shunt ◽

Closure Rate ◽

Term Outcome ◽

Long Term Outcome ◽

Surgical Closure ◽

Interventional Closure ◽

Term Data

Abstract Interventional closure of congenital ventricular septal defects (VSD) is recording a continuous rise in acceptance. Complete atrioventricular block (cAVB) and residual shunting are major concerns during follow-up, but long-term data for both are still limited. We retrospectively evaluated the outcome of patients with interventional VSD closure and focused on long-term results (> 1 year follow-up). Transcatheter VSD closures were performed between 1993 and 2015, in 149 patients requiring 155 procedures (104 perimembranous, 29 muscular, 19 residual post-surgical VSDs, and 3 with multiple defects). The following devices were used: 65 × Amplatzer™ Membranous VSD Occluder, 33 × Duct Occluder II, 27 × Muscular VSD Occluder, 3 × Duct Occluder I, 24 × PFM-Nit-Occlud®, and 3 × Rashkind-Occluder. The median age at time of implantation was 6.2 (0.01–66.1) years, median height 117 (49–188) cm, and median weight 20.9 (3.2–117) kg. Median follow-up time was 6.2 (1.1–21.3) years and closure rate was 86.2% at last follow-up. Complications resulting in device explantation include one case of cAVB with a Membranous VSD occluder 7 days after implantation and four cases due to residual shunt/malposition. Six (4%) deaths occurred during follow-up with only one procedural related death from a hybrid VSD closure. Overall, our reported results of interventional VSD closure show favorable outcomes with only one (0.7%) episode of cAVB. Interventional closure offers a good alternative to surgical closure and shows improved performance by using softer devices. However, prospective long-term data in the current era with different devices are still mandatory to assess the effectiveness and safety of this procedure.

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Long-term results of percutaneous balloon valvuloplasty in neonatal critical pulmonary valve stenosis: a 20-year, single-centre experience

Cardiology in the Young ◽

10.1017/s1047951117000178 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1314-1322

Author(s):

Petra Loureiro ◽

Barbara Cardoso ◽

Inês B. Gomes ◽

José F. Martins ◽

Fátima F. Pinto

Keyword(s):

Pulmonary Valve ◽

Pressure Ratio ◽

Balloon Valvuloplasty ◽

Long Term Results ◽

Pulmonary Valve Stenosis ◽

Single Centre ◽

Percutaneous Balloon ◽

Percutaneous Balloon Valvuloplasty

AbstractIntroductionPercutaneous balloon valvuloplasty is the primary treatment for critical pulmonary valve stenosis in neonates. Thus far, a few studies have reported long-term results of this technique in neonatal critical pulmonary valve stenosis.MethodsWe carried out a retrospective study of all consecutive newborns with critical pulmonary valve stenosis subjected to percutaneous balloon valvuloplasty at a single centre, between 1994 and 2014, to assess its immediate and long-term safety and efficacy.ResultsA total of 24 neonates presented with critical pulmonary valve stenosis. The mean diameter of the pulmonary annulus was 7 mm (±1.19); 33.3% had a dysplastic pulmonary valve, and 92% were started on prostaglandin E1 treatment. Percutaneous balloon valvuloplasty was performed at a mean age of 4.0±4.3 days using, on average, a balloon-to-pulmonary annulus ratio of 1.18 mm (with a range from 0.9 to 1.43). Immediate success was achieved in 22/24 patients (92%) with a reduction in the pulmonary transvalvular peak gradient (p<0.05) and in the right ventricle/systemic pressure ratio (p<0.05). There was one death (4%) 6 days after the procedure, and 29.2% of them had transient rhythm complications. For a mean follow-up time of 8.4 years, the re-intervention rate was 42.9%. In total, 14 re-interventions were performed in nine neonates, including surgery in six. Freedom from re-intervention was 50% at 8 years and 43% at 10 and 15 years.ConclusionThis series, to the best of our knowledge, has had the longest follow-up of neonates with critical pulmonary valve stenosis. Percutaneous balloon valvuloplasty is a safe and effective treatment, and in our study 75% of the patients were exclusively treated using this technique.

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Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

Pediatric Cardiology ◽

10.1007/s00246-021-02685-z ◽

2021 ◽

Author(s):

Chiara Minotti ◽

Manuela Scioni ◽

Biagio Castaldi ◽

Alvise Guariento ◽

Roberta Biffanti ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Coarctation ◽

Surgical Repair ◽

Nyha Class ◽

Long Term Results ◽

Relative Risk Ratio ◽

Hypoplastic Aortic Arch ◽

Long Term Experience

AbstractTo evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

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Abstract 2163: Long-term Follow-up (>3 Years) of Patients Treated With Sirolimus-Eluting Stents for In-stent Restenosis. Results of a Randomized Study.

Circulation ◽

10.1161/circ.116.suppl_16.ii_469-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Fernando Alfonso ◽

Maria J Perez-Vizcayno ◽

Armando Bethencourt ◽

Vicens Martí ◽

Jose R Lopez-Minguez ◽

...

Keyword(s):

Clinical Outcome ◽

Randomized Study ◽

Bare Metal Stent ◽

Long Term Results ◽

Target Vessel Revascularization ◽

Angiographic Restenosis ◽

Stent Restenosis ◽

In Stent Restenosis

Background: The value of drug-eluting stents in patients (P) with in-stent restenosis (ISR) has been established. However, the long-term results of this strategy in P with ISR remains unknown. Objective: We sought to determine the long-term clinical outcome of P treated with sirolimus-eluting stents (SES) for ISR. Methods: A systematic, pre-specified, long-term clinical follow-up (FU) was performed in all P included in the RIBS II (Restenosis Intra-stent: Balloon angioplasty [BA] vs elective SES implantation) randomized trial. In RIBS II 150 P with ISR after bare-metal stent implantation were included: 74 allocated to BA and 76 to SES. Late angiography was obtained in 96% of eligible P. A structured clinical questionnaire (cardiac/non cardiac death, myocardial infarction [MI], target vessel revascularization [TVR], thrombosis [TH], and medical therapy) was used during FU. Results: Angiographic restenosis (primary end-point) was more frequently found in the BA arm (39% vs 11%, p<0.001). Clinical FU at 1-year was obtained in 150 P (100%). During this time period 6 P died (3 SES, 3 BA), 4 P suffered a MI (2 SES, 2 BA), 2 P experienced TH (1 P in each arm) and 30 required TVR (8 SES, 22 BA, p<0.01). A complete clinical FU >3 years was obtained in 145 P (97%) (mean 38±9 months, median 40 months [IQR 37–42]). Late events (after 1 year, non-exclusive) included: 3 deaths (1 SES, 2 BA), 3 MI (3 SES, 2 due to late TH) and 7 late TVR (5 SES, 2 BA). At 4 years, event-free survival was 76% in the SES arm and 65% in the BA arm (p=0.03). Survival free from TVR at 4 years was 80% in the SES arm and 67% in the BA arm (p=0.02). Conclusion: In P with ISR SES implantation improve the long-term clinical outcome as compared with BA treatment.

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Carotid endarterectomy for treatment of carotid in-stent restenosis: long-term follow-up results and surgery experiences from one single centre

Stroke and Vascular Neurology ◽

10.1136/svn-2017-000089 ◽

2017 ◽

Vol 2 (3) ◽

pp. 140-146 ◽

Cited By ~ 7

Author(s):

Le-Bao Yu ◽

Wei Yan ◽

Qian Zhang ◽

Ji-Zong Zhao ◽

Yan Zhang ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Single Centre ◽

Stent Restenosis ◽

Long Term Follow Up ◽

In Stent Restenosis

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Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211003505 ◽

2021 ◽

Vol 12 (4) ◽

pp. 492-499

Author(s):

Louis Heremans ◽

Arnaud Henkens ◽

Geoffroy de Beco ◽

Karlien Carbonez ◽

Stéphane Moniotte ◽

...

Keyword(s):

Aortic Coarctation ◽

Interrupted Aortic Arch ◽

Long Term Results ◽

Coarctation Repair ◽

Group 3 ◽

Group 2 ◽

Patient Prognosis ◽

Group 1

Background: Aortic coarctation is among the most common cardiovascular congenital abnormalities requiring repair after birth. Besides mortality, morbidity remains an important aspect. Accordingly, we reviewed our 20-year experience of aortic coarctation repair by thoracotomy, with emphasis on both short- and long-term outcomes. Methods: From 1995 through 2014, 214 patients underwent coarctation repair via left thoracotomy. Associated arch lesions were distal arch hypoplasia (n = 117) or type A interrupted aortic arch (n = 6). Eighty-four patients had isolated coarctation (group 1), 66 associated ventricular septal defect (group 2), and 64 associated complex cardiac lesions (group 3). Median follow-up was 8.4 years. Results: There was one (0.5%) procedure-related death. Nine (4.2%) patients died during index admission. In-hospital mortality was 0.7% in group 1 and 2 and 12.5% in group 3 ( P < .001). No patient had paraplegia. Actuarial five-year survival was 97.5% in group 1, 94% group 2 and 66% in group 3. Recurrent coarctation developed in 29 patients, all but four (1.8%) successfully treated by balloon dilatation. Freedom from reintervention (dilatation or surgery) at five years was 86%. At hospital discharge, 28 (13.5%) patients were hypertensive. At follow-up, hypertension was present in 11 (5.3%) patients. Conclusions: Long-term results of aortic coarctation repair by thoracotomy are excellent, with percutaneous angioplasty being the procedure of choice for recurrences. Patient prognosis is dependent on associated cardiac malformations. In this study, the prevalence of late arterial hypertension was lower than previously reported.

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Abstract 2156: In-Stent Restenosis after Sirolimus-Eluting Stent Implantation is Related to Coronary Stent Fracture

Circulation ◽

10.1161/circ.116.suppl_16.ii_467-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

SY Lee ◽

MH Kim ◽

CM Ahn ◽

JS Kim ◽

DH Choi ◽

...

Keyword(s):

Coronary Angiography ◽

Stent Implantation ◽

Time Interval ◽

Stent Fracture ◽

Fracture Group ◽

Stent Restenosis ◽

Sirolimus Eluting Stent ◽

Stent Diameter ◽

In Stent Restenosis

Background and objectives : It has been reported in few studies about relationship between sirolimus-eluting stent (SES) fracture and in-stent restenosis (ISR). Therefore, authors investigated clinical characteristics of the SES fracture and the association with ISR. Subjects and Methods : From December 2003 to February 2006, implantation and follow-up coronary angiography(CAG) for 796 sirolimus-eluting stents were carried out in Severance hospital. We reviewed clinical, procedural and structural factors which might affect SES fracture and ISR. Results : Twenty four fractures after 796 SES implantation were identified by follow-up coronary angiography, sixteen cases in the left anterior descending artery and eight in the right coronary artery. The median time interval from stent implantation to follow up CAG was 9.0 months [range: 2 ~ 30 months]. No statistical difference was found in stent diameter (fracture group 3.06 ± 0.32 mm vs non-fracture group 3.08 ± 0.31 mm, P=0.778). Length of fractured stents was longer than non-fractured stents (30.29 ± 4.16 mm vs 24.51 ± 6.18 mm, P<0.001). The binary ISR rate in the stent fracture group was higher compared to non-fracture group (50% vs 4.4%, p < 0.001). Predictors for ISR estimated by multivariate analysis were stent fracture (OR=33.6, p < 0.001), stent diameter less than 3.0 mm (OR=2.84, p =0.015) and stent length over 28 mm (OR = 3.10, p = 0.023). Among twelve cases which had both binary restenosis and stent fracture, eight cases were treated by balloon angioplasty or additional stent implantation considering the condition of patients. Conclusion : Stent fracture may be one of the crucial mechanisms of ISR after implantation of SES. However, further studies in larger scale are required to define the incidence, predisposing factors, and clinical outcomes of SES fracture.

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