O-6
Long-term Outcomes of the Coarctation of the Aorta Stent Trials
Presenter
Neil C Tailor, M.D., NewYork-Presbyterian, Columbia Doctors, New York, NY
Neil C Tailor, M.D.1, Ralf J. Holzer, M.D., MSc, FSCAI2, Kimberlee Gauvreau, ScD3, Kerry Mcenaney3 and Richard E. Ringel, M.D.4, (1)NewYork-Presbyterian, Columbia Doctors, New York, NY, (2)The University of California, Davis, Sacramento, CA, (3)Children's Hospital Boston, Boston, MA, (4)The Johns Hopkins Hospital, Baltimore, MD
Keywords: Adult Congenital Heart Disease (ACHD), Complications and Congenital Heart Disease (CHD)
Background:
Comparing percutaneous treatment of coarctation of the aorta (CoA) versus surgical repair has been difficult, as acute results may not necessarily correlate with long term outcomes. We report up to five years of post-implant follow-up (FU) in patients enrolled into the COAST/ COAST II trials, which evaluated the use of bare/covered Cheatham-Platinum Stents for the treatment of CoA and/or associated aortic wall injury (AWI).
Methods:
Data was prospectively collected during the two multi-center studies, enrolling 248 patients (COAST: n=121, COAST II: n=127). Late FU data (48-60 month) was compared to immediate (1 month) and early (12 months) FU.
Results:
There was a decrease in use of anti-hypertensive medication, from 53% at immediate, to 42% at early and 29% at late FU. The upper-to-lower limb blood pressure gradient at late FU was <10/<20mmHg in 80%/91.3% of patients. The cumulative incidence of stent fractures/reinterventions/AWI was 0%/1.5%/0% immediately, 2.9%/5.1%/1.2% at early, and 24.4%/21.3%/6.3% at late FU. There were no surgical reinterventions. The incidence of aneurysms was similar for bare and covered CP stents (5%/5.5%). Independent predictors (late FU): reintervention - age <18 years, post implantation systolic arm-leg blood pressure (BP) gradient >=10mmHg, minimum stent diameter at implantation <12mm, and initial CoA minimum diameter <6mm; stent fractures - age <18 years, male gender, minimum stent diameter at implantation >=12mm, use of bare stent.
Conclusions
:
CoA stenting is effective at maintaining obstruction relief and remaining free of surgical reintervention up to 60 months post implant. Most reinterventions are planned re-expansions (staged/ interval growth). Covered stents appear to confer protection over bare metal stents from the development of stent fractures although the rate of late aneurysm formation was no different.