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. 2022 Jul;13(4):426-435.
doi: 10.1177/21501351221099933.

Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta

Philippe Grieshaber  1 , Moritz Merbecks  2 , Christoph Jaschinski  1 , Elizabeth Fonseca  1 , Raoul Arnold  2 , Matthias Karck  1 , Matthias Gorenflo  2 , Tsvetomir Loukanov  1
Affiliations

Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta

Philippe Grieshaber et al. World J Pediatr Congenit Heart Surg. 2022 Jul.

Abstract

Background: Neonatal coarctation of the aorta (CoA) is primarily treated by surgical repair. However, under certain high-risk constellations, initial stent angioplasty may be considered followed by surgical repair. We report our experience with this staged approach. Methods: All patients undergoing surgical CoA repair following prior stenting at our institution between January 2011 and December 2019 were included in this retrospective analysis. The patients were classified to be at high risk because of cardiogenic shock, associated complex cardiac malformations, neonatal infection, necrotizing enterocolitis, and extracardiac conditions, respectively. Outcomes were analyzed and compared with neonates who underwent surgical CoA repair without prior stenting in the same observation period.

Results: Twenty-six neonates received stent implantation at a median age of 20 days (IQR 9-33 days). Subsequent surgical repair was conducted at an age of 4.2 months (IQR 3.2-6.1 months) with a median body weight of 5.6 kg (IQR 4.5-6.5 kg). Cardiopulmonary bypass was applied in 96% of cases. Extended end-to-end anastomosis was possible in 11 patients. Extended reconstruction with patch material was necessary in the remaining patients. One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 5.2 years after initial stenting, all remaining patients were alive; 15/25 patients (60%) were free from re-intervention. Of note, re-intervention rates were comparable in neonates (n = 76) who were operated on with native CoA (28/74 patients; 38%; P = .67).

Conclusions: Neonatal stent angioplasty for CoA results in increased complexity of the subsequent surgical repair. Nevertheless, this staged approach allows to bridge high-risk neonates to later surgical repair with reduced perioperative risk and acceptable midterm outcomes.

Keywords: aortic coarctation; cardiac catheterization; pediatric emergency medicine; stents; thoracic surgery.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Pressure gradient over the coarctation region before and after stenting.
Figure 2.
Figure 2.
Age at stenting and surgical CoA repair. The median delay between stenting and surgical CoA repair was 92 days. CoA, coarctation of the aorta; d, days.
Figure 3.
Figure 3.
Peak velocity at the isthmus region before and after stenting and before and after surgical repair.
Figure 4.
Figure 4.
Long-term follow-up Kaplan Meier-estimations of (A) survival, (B) freedom from re-interventions after the staged approach or surgical repair of native CoA, (C) freedom from re-intervention according to surgical technique in stented CoA, and (D) freedom from re-intervention according to surgical technique in native CoA. CoA, coarctation of the aorta.
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References

    1. Tsang V, Haapanen H, Neijenhuis R. Aortic coarctation/arch hypoplasia repair: how small is too small. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2019;22:10‐13. - PubMed
    1. Sandrio S, Karck M, Gorenflo M, Loukanov T. Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation *. Cardiol Young. 2014;24(1):113‐119. - PubMed
    1. Arfi AM, Galal MO, Kouatli A, Baho H, Abozeid H, Al Ata J. Stent angioplasty for critical native aortic coarctation in three infants: up to 15-year follow-up without surgical intervention and review of the literature. Pediatr Cardiol. 2018;39(8):1501‐1513. - PubMed
    1. Rao PS, Thapar MK, Galal O, Wilson AD. Follow-up results of balloon angioplasty of native coarctation in neonates and infants. Am Heart J. 1990;120(6 Pt 1):1310‐1314. - PubMed
    1. Radtke WAK, Waller BR, Hebra A, Bradley SM. Palliative stent implantation for aortic coarctation in premature infants weighing<1,500 g. Am J Cardiol. 2002;90(12):1409‐1412. - PubMed

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