ABSTRACT
BACKGROUND: In young patients with native aortic coarctation (CoA), the management of choice is surgery. However, in re-coarctation (re-CoA) surgery is associated with increased morbidity and even mortality. Some children with native CoA present relative contraindications for surgery. METHODS: From 2006 to 2017, thirty-four patients (male nâ¯=â¯20; 59%) from two centres with re-CoA (31) and native CoA (3) were managed by stent implantation with premounted balloon expandable stents. Inclusion criteria were ageâ¯<â¯3â¯years and >1â¯month, weightâ¯<â¯16â¯kg. Median age was 6,5â¯months (min. 1; max. 34â¯months), median weight 6,2â¯kg (min. 3,7; max. 16â¯kg). Thirteen patients (38%) had Re-CoA and hypoplastic left heart syndrome (HLHS). In three patients (9%) the native CoA was stented due to contraindications for surgical treatment. RESULTS: All procedures were successful. The median peak invasive systolic pressure gradient declined from 31â¯mmâ¯Hg (max. 118; min. 4) to 0â¯mmâ¯Hg (max. 32; min.-7) (pâ¯<â¯0.001). The median minimal diameter of the narrowed segment of aorta increased from 3â¯mm (max. 6,9; min. 1,0) to 7â¯mm (max. 11,5; min. 3,5) (pâ¯<â¯0.001). There were no serious complications. The median follow-up time was 12,5â¯months (max. 88; min. 0â¯month). During this time ten patients (29%) required re-dilatation and two of them re-stenting. CONCLUSION: Percutaneous stent implantation for Re-CoA and in selected patients for native CoA can be performed successfully in very young patients with a good immediate hemodynamical result. However, repeated stent angioplasties and further on interventional 'opening' of the stent is necessary to augment the aorta to adult size.