Native aortic coarctation stenting in patients ≥ 46 years old

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Aortic coarctation (CoA) is a congenital heart defect often diagnosed in childhood, but can affect adolescents and adults.
• Stent implantation has emerged as a viable treatment for CoA in younger populations.
• Limited data exists on the efficacy and safety of stent implantation for native CoA in elderly patients.

Purpose of the Study:

• To evaluate the outcomes of stent implantation in a unique cohort of patients aged 46 years and older with native coarctation of the aorta.
• To assess the safety and effectiveness of using bare metal or covered stents in this specific patient demographic.

Main Methods:

• Retrospective analysis of 24 patients (age ≥46 years) who underwent stent implantation for native CoA between 2002 and the study period.
• Procedures utilized femoral access and the Mullins technique, employing various bare metal and covered stents.
• Data collected included procedural success, pre- and post-procedure gradients, lumen diameter changes, and complications.

Main Results:

• All stent implantations were technically successful in reducing the coarctation gradient to <20 mm Hg.
• Mean aortic gradient significantly decreased from 50.6 mmHg to 6.8 mmHg (p < 0.001).
• Mean lumen diameter increased from 5.5 mm to 14.9 mm (p < 0.001), despite two instances of bare metal stent migration. One patient experienced a central nervous system stroke.

Conclusions:

• Stent implantation is a safe and effective procedure for treating native aortic coarctation in elderly patients (≥46 years).
• The intervention provides persistent relief from aortic obstruction in this older demographic.
• Careful patient selection and procedural technique are crucial, given potential complications like stent migration and stroke.