NCDR Study: Catheter Interventions as a Safe, Effective Treatment For Native Aortic Coarctation in Older Children, Adults
Catheter intervention for native coarctation of the aorta was found to be a safe treatment with a high rate of procedural success in older children and adults, according to a recent study published in the Journal of the Society for Cardiovascular Angiography & Interventions.
Ada C. Stefanescu Schmidt, MD, FACC, et al., looked at 1,187 procedures performed on patients with native aortic coarctation captured by ACC's IMPACT Registry over an eight-year period. They found that stenting was used in more than half of children older than one year and >90% of patients older than eight years. Procedural success, defined as no major adverse events and a final peak gradient <20 mm Hg, was achieved in >90% of stenting procedures but only 69% of procedures using balloon angioplasty.
After adjusting for age and baseline characteristics, the researchers found that stent implantation was associated with a higher likelihood of optimal outcome, defined as a final gradient <10 mm Hg. They also note that major adverse events occurred in 14% of cases where the patient was less than one year old and in 2-2.5% of cases with patients aged one to 18 years, and 6.6% of patients older than 18 years. Major adverse events were more likely to occur after balloon angioplasty than after stenting (odds ratio, 0.5; 95% CI, 0.28-0.9; unadjusted p=0.02).
The study authors acknowledge that while the combined rate of major adverse events was low, complex neonatal anatomy demonstrated the highest risk and vascular complications drove adverse events overall.
"Although these results certainly support the continued use of transcatheter interventions for native [coarctation of the aorta] in patients aged >8 years, these should not necessarily discourage the use of the technique in younger children," state Stefanescu Schmidt, et al. "It is important to note that stenting in neonates and infants is usually performed as a bridge to another procedure because the diameter of small stents (coronary stents in particular) cannot be expanded to diameters adequate for aortic size in adults."
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging
Keywords: IMPACT Registry, National Cardiovascular Data Registries, Infant, Newborn, Child, Preschool, Aortic Coarctation, Odds Ratio, Angioplasty, Balloon, Stents, Catheters, Angiography, Registries, Neoplasm Recurrence, Local
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