Percutaneous coronary artery interventions in the paediatric population: Periprocedural and late outcome
Zakaria Jalal1, Jean-François Piechaud2, Olivier Villemain1
1Paediatric Cardiology, Centre de référence malformations cardiaques congénitales complexes, M3C, Necker Hospital for Sick Children, Assistance Publique des hôpitaux de Paris, 75105 Paris, France.
Insights
Percutaneous coronary interventions (PCIs) in children are feasible for various conditions, though emergency procedures and interventions in neonates present challenges. Balloon angioplasty without stenting was linked to poorer outcomes in pediatric PCI.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Percutaneous coronary interventions (PCIs) are standard for adult ischemic heart disease.
- Limited data exists on PCI efficacy and safety in pediatric populations.
Purpose of the Study:
- To evaluate indications, techniques, and outcomes of PCI in children.
- To analyze factors influencing survival after pediatric PCI.
Main Methods:
- Retrospective review of pediatric PCI cases (1998-2015) from two French centers.
- Exclusion of diagnostic coronary angiograms.
- Analysis of procedural success, complications, and long-term outcomes.
Main Results:
- 40 PCIs were performed in 29 children (median age 6.5 years).
- 36/40 obstructions were successfully treated; 23 lesions received stents.
- 36-month survival free from death/reintervention was 79%/60%; early age, emergency, and balloon-only angioplasty correlated with worse survival.
Conclusions:
- PCI is applicable to diverse pediatric coronary anatomies.
- PCI can be effective in selected pediatric cases.
- Emergency PCI and neonatal interventions pose significant challenges.
Background:
Percutaneous coronary interventions (PCIs) are generally performed in adults with ischaemic heart disease, but reports of experience in the paediatric population are relatively limited.
Aims:
To report indications, interventional techniques and procedural outcomes for PCI in children treated in two French institutions.
Methods:
Medical records of all children in whom a PCI was attempted in two French tertiary institutions between 1998 and 2015 were systematically reviewed. Diagnostic procedures, including coronary angiograms, were excluded.
Results:
A total of 40 PCIs were attempted in 29 patients (median age 6.5 years, range three days to 17.9 years). Nineteen procedures (47.5%) were performed on an emergency basis. A total of 36/40 coronary obstructions were successfully treated, with no immediate residual postintervention stenosis. Initial balloon angioplasty was performed for all lesions, with subsequent stent placement in 23 lesions. There were two periprocedural and five late deaths. After a median follow-up of 12 months (range 1 week to 115 months), freedom from death and reintervention at 36 months were 79% and 60%, respectively. Age<1 month, emergency procedure and balloon angioplasty without stent implantation were associated with shorter survival.
Conclusion:
PCI can be used in the paediatric population in a wide range of anatomical conditions; it may be effective in selected patients, but remains challenging when performed in emergency and/or in neonates.
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