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Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience
Mouafak Homsi1, Maya El Khoury2, Caroline Hmedeh1
1American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon.
Insights
Endovascular stenting for coarctation of the aorta (CoA) is safe and effective in developing countries. This procedure offers outcomes comparable to those in developed nations, even with limited resources.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coarctation of the aorta (CoA) is a common congenital heart defect associated with high morbidity and mortality.
- Effective treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the safety and feasibility of endovascular stenting for CoA in a resource-limited setting.
- To compare outcomes of CoA stenting in a developing country with international benchmarks.
Main Methods:
- Retrospective review of 18 patients who underwent endovascular stent repair for aortic coarctation since 2009.
- Analysis of procedural success, hemodynamic changes, blood pressure, and complications.
Main Results:
- Successful stent implantation in all patients with a 94% procedural success rate.
- Significant reduction in systolic gradient (42.9 mmHg) and 72.2% of patients achieved normal blood pressure.
- Low complication rates, with no dissections or aneurysms detected; minor complications in two patients.
Conclusions:
- Endovascular stenting for de novo or recurrent CoA is feasible and safe in developing countries.
- Outcomes are comparable to those reported in developed countries.
- A multidisciplinary team approach is essential for success in resource-limited settings.
Background/Purpose:
CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks.
Materials/Methods:
A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done.
Results:
18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p < 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications.
Conclusions:
Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.
