Medium-Term Outcomes of Stent Therapy for Aortic Coarctation in Children Under 30 kg with New Generation Low-Profile Stents: A Follow-Up Study of a Single Centre Experience.

We previously reported short-term outcomes for stenting of aortic coarctation (CoA) (native or re-coarctation) with newer generation low-profile stents (Valeo, Formula, and Begraft stents) in children under 30 kg. We present here the medium-term outcomes of this procedure. Retrospective review of patients weighing under 30 kg who had percutaneous stent treatments for coarctation between 2012 and 2021 was performed. Clinical and procedural data were collected; 19 patients were included. The median age at the time of procedure was 5.1 [4.1-6.4] years and median weight 21.0 [17.3-22.3] kg. One patient had a history of re-coarctation. Thirteen (68%) patients were on anti-hypertensives pre-procedure. Different types of stents were used (14 Valeo™, 4 Formula® 535, 1 BeGraft), which can all be dilated to 18 mm or larger. One patient required a 9 F sheath, all others required a 7 F sheath. The narrowest diameter in the aorta increased from a median of 3.5 [3.0-4.5] to 9.4 [8.9-9.8] mm, p < 0.001; there was a reduction in the median pressure gradient across the coarctation from 35.0 [30.0-43.0] to 5.0 [0-10.0] mmHg, p < 0.001. There were no intra-procedural complications. Follow-up was for a median of 56.0 [13.0-65.0] months. Five (26%) of patients underwent re-intervention after a median time frame of 40.0 [39.5-52.0] months; four had balloon dilation, one had repeat stent implantation. Five (26%) patients were on anti-hypertensive agent(s) post-intervention. Our single centre experience demonstrates that percutaneous stenting for coarctation of aorta in children under 30 kg, with low-profile stents, had no significant complications during the median follow-up time of 56 months. This study demonstrated that the procedure is safe and effective for short and medium-term therapy in this group of patients with a 26% re-intervention rate. A quarter of patients remained on anti-hypertensive medication post stenting, emphasizing the importance of long-term follow-up.

Balloon Atrial Septostomy: Does the Balloon Size Matter?

Background: Dextro-transposition of the great arteries is a congenital heart defect with eventually lethal life-threatening consequences of hypoxic low cardiac output. When a balloon atrial septostomy (BAS) is needed, it is performed shortly after birth to create an interatrial shunt and improve systemic blood oxygenation and haemodynamic conditions. In 2019 and 2020, the withdrawal of some balloon atrioseptostomy catheters from the market led to increased use of catheters with different materials, shapes, and sizes. The main objective of this study was to investigate whether the size of the Miller and Fogarty balloon (Edwards Lifesciences) in its 2 variations, the 4.0 cc and the 1.8 cc, had a different impact on the systemic oxygen saturation, on the atrial septal defect (ASD) size, or on the type and frequency of procedure-related complications. Methods: We conducted a retrospective study on 134 consecutive patients diagnosed with dextrotransposition of the great arteries between 2002 and 2018 who underwent BAS in a tertiary paediatric hospital in Canada. Results: BAS resulted in a significant increase in oxygen saturation of 18.91% ± 12.95% points (P < 0.0001) and a significant increase in the resulting ASD by 3.92 ± 1.58 mm (P < 0.0001). There was no significant difference in resulting oxygen saturation (P = 0.8370) or the final ASD size (P = 0.2193) based on the balloon size. Severe or life-threatening complications were rare (1%) with no subsequent patient demise. Conclusions: This is the first study to show that the small balloon is as efficient as the large balloon catheter including in premature patients. This raises the question whether different balloon sizes are necessary.

Contexte: La dextro-transposition des gros vaisseaux (dTGV) est une cardiopathie congénitale dont les conséquences peuvent être mortelles en raison du bas débit cardiaque et de l'état hypoxique. Lorsqu'une septostomie auriculaire par ballonnet est nécessaire, l'intervention est réalisée après la naissance pour créer une communication interauriculaire (CIA); cette ouverture améliore l'oxygénation de la circulation sanguine systémique ainsi que les conditions hémodynamiques. En 2019 et en 2020, le retrait du marché de certains cathéters utilisés lors des septostomies auriculaires par ballonnet a entraîné une hausse de l'usage de nouveaux cathéters offerts en différentes formes et tailles. L'objectif principal de cette étude était de déterminer si la différence de taille des ballonnets de Miller et de Fogarty (Edwards Lifesciences), respectivement de 4,0 cc et de 1,8 cc, a un effet sur la saturation en oxygène de la circulation sanguine systémique, sur la taille de la CIA ou sur le type et la fréquence des complications liées à l'intervention. Méthodologie: Nous avons mené une étude rétrospective comptant 134 patients consécutifs qui ont présenté une dTGV entre 2002 et 2018 et qui ont subi une septostomie auriculaire par ballonnet dans un hôpital pédiatrique tertiaire canadien. Résultats: Les septostomies auriculaires par ballonnet ont donné lieu à une hausse significative de 18,91 ± 12,95 points de pourcentage (p < 0,0001) de la saturation en oxygène et à une hausse significative de 3,92 ± 1,58 mm (p < 0,0001) de la CIA qui a résulté de l'intervention. La taille du ballonnet n'a pas entraîné de différence significative en ce qui concerne la saturation en oxygène qui a résulté de l'intervention (p = 0,8370) ou la taille finale de la CIA (p = 0,2193). Les complications graves ou mettant la vie du patient en danger ont été rares (1 %) et aucun patient n'est décédé suite à l'intervention. Conclusion: Il s'agit de la première étude qui démontre que le petit ballonnet est aussi efficace que le gros ballonnet, y compris chez les enfants prématurés. Cette conclusion soulève la question à savoir si différentes tailles de ballonnets sont nécessaires.