Percutaneous Stent Placement for Coarctation of the Aorta for Patients Less Than 25 Kilograms: A Safe Strategy?
Presenter
Lindsay F Eilers, MD, Texas Children's Hospital, Houston, TX
Lindsay F Eilers, MD1, Melissa K Webb, MD1, Manish Bansal, MD1, Jolie J Britt, MD1, Amna Qasim, MD1 and Gary E. Stapleton, MD, FSCAI2, (1)Texas Children's Hospital, Houston, TX, (2)Medical City Children’s Hospital, Dallas, TX
Keywords: Congenital Heart Disease (CHD)
Background
Stent implantation is an accepted treatment for aortic coarctation (CoA) in older children and adolescents. However, there is limited data regarding feasibility and safety for smaller patients. With improved technology and procedural technique, stent implantation is feasible in select patients weighing less than 25kg. We report our experience and outcomes for percutaneous CoA stent placement in this patient population.
Methods
Single center retrospective review of patients less than 25 kg undergoing stent placement for CoA from 2000-2021. Patients were divided into 2 groups: single ventricle (SV) and biventricular (BV) circulation.
Results
36 patients underwent CoA stenting from 1/2000- 1/2021: 11 with SV circulation and 25 with BV. All SV patients underwent CoA stenting for recurrent CoA. Only 7/25 BV patients were treated for recurrent CoA while 18/25 were treated for native CoA, p <0.001. Median age was 3 months (1.6-7) for SV and 7 months (4.8-61) for BV, p=0.41. Median weight was 7 kg (5.7-8.6) for SV and 19.6 kg (14.7-22.3) for BV, p<0.001. A retrograde approach was used most often in both groups, with 7 (64%) in the SV group and 24 (96%) in the BV group, p=0.023. Median sheath size was smaller for the SV group, 7 Fr [SD 2], compared to 9 Fr [SD 3] in the BV group, p=0.059. The most commonly used stent was Intrastent Max LD (12) followed by Palmaz Genesis XD (10), CP (6), Valeo (4), Formula (3) and Multilink Vision (2). The median initial stent diameter was 10mm. There were no major adverse events in the SV group and only 1 in the BV group (iliac artery avulsion requiring emergent surgical intervention), p=0.694. There were no procedure related deaths. During median follow up of 40 months, 25 patients have undergone 44 total subsequent re-interventions. 23 had further balloon angioplasty of the existing stent, while 2 required additional stent placement. 3 SV patients underwent heart transplant during which the stents were left in place. No further stent angioplasty was required in the transplanted patients.
Conclusions
CoA stenting can be safely and effectively performed in patients less than 25 kg as an alternative to surgical intervention. Further interventions to dilate the stent for patient growth will likely be required.